王立坤 张素梅 武雪亮

[摘要] 目的 探討血浆脑钠肽（BNP）联合心肌综合指数（Tei）评价病毒性肝炎肝硬化患者心功能的价值。 方法 选取河北北方学院附属第一医院消化内科2014年12月～2016年12月收治的80例病毒性肝炎肝硬化患者，根据Child-Pugh肝功能分级标准分为代偿期组（Child A组30例）、失代偿期组（Child B组25例和Child C组25例），另选取健康者25名作为对照组。采用酶联免疫分析（ELISA）法检测各组的血浆BNP水平，并行超声Tei指数检测。 结果 Child B和Child C组血浆BNP水平明显高于Child A组和对照组，Child C组血浆BNP水平明显高于Child B组，差异均有统计学意义（P < 0.05）；Child B和Child C组左心室的Tei指数和IRT/ET值均明显高于Child A组和对照组，Child C组Tei指数和IRT/ET明显高于Child B组，差异均有统计学意义（P < 0.05）；而各组右心室Tei指数和IRT/ET值比较差异无统计学意义（P > 0.05）；血浆BNP和左心室Tei指数在诊断和监测病毒性肝炎肝硬化患者心功能方面具有一致性（r = 0.655，P < 0.01）；多元回归分析显示：左心室Tei指数为血浆BNP的独立危险因素（P < 0.01）。 结论 血浆BNP联合Tei指数能准确评估病毒性肝炎肝硬化患者心功能的变化，为临床治疗和监测提供科学参考。

[关键词] 血浆钠尿肽；心肌综合指数；病毒性肝炎肝硬化；心功能；临床研究

[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0127-05

[Abstract] Objective To investigate the value of brain natriuretic peptide （BNP） combination with Tei index in evaluating the cardiac function of patients with viral hepatitis cirrhosis. Methods Eighty patients with viral hepatitis cirrhosis treated in Department of Gastroenterology， the First Affiliated Hospital of Hebei North University from December 2014 to December 2016 were selected and divided into compensatory stage group （Child A group 30 cases） and non compensatory stage （Child B group 25 cases and Child C group 25 cases） according into Child-Pugh liver function grading standard. Another 20 healthy volunteers were selected as the healthy control group. The plasma BNP level was detected by ELISA method and Tei index was detected by colour doppler imaging. Results The plasma BNP level in the Child B and the Child C group was higher than that in the Child A group and the control group； the plasma BNP level in the Child C group was higher than that in the control group， and there was significant difference （P < 0.05）. The Tei index of left ventricle and IRT/ET value in the Child B and the Child C group were higher than those in the Child A group and the control group. The Tei index of left ventricle and IRT/ET value in the Child C group were higher than those in the control group， and there were also significant differences （P < 0.05）. While there was no difference in Tei index and IRT/ET value of right ventricle in all the groups （P > 0.05）. The plasma BNP and Tei index were consistent in assessing cardiac function in patients with viral hepatitis cirrhosis （r = 0.655， P < 0.01）. Multiple stepwise regression analysis showed that the Tei index of left ventricle was independent risk factor of plasma BNP （P < 0.01）. Conclusion The plasma BNP combination with Tei index could accurately assess the changes of cardiac function in patients with viral hepatitis cirrhosis and provide a scientific reference for clinical treatment and monitoring.

[Key words] Brain natriuretic peptide； Tei index； Alcoholic cirrhosis； Cardiac function； Clinical research

尽管近年来我国病毒性肝炎发展有抑制趋势，但总体来看，我国仍然是病毒性肝炎大国，以乙型肝炎、丙型肝炎为主的各型病毒性肝炎均有发展至肝纤维化、肝硬化的可能[1]。病毒性肝炎肝硬化早期的代偿阶段无明显心功能改变，当发展到失代偿期后其循环系统即呈现高动力状态，表现为心输出量、心率增加，但由于外周血管阻力下降，导致动脉压降低，外周血容量分布异常，进而引起神经体液调节紊乱、血管活性物质分泌异常，各种离子通道紊乱，并逐步导致心肌结构及功能病变[2-3]。

心肌综合指数（MPI或Tei指数），是指心室等容收缩时间（isometric contraction time，ICT）與等容舒张时间（isovolumic relaxation time，IRT）之和与射血时间（ejection time，ET）的比值，能综合监测心功能变化，反映心脏收缩与舒张功能，且不受仪器条件、心率、血压、心室几何构型等相关因素的影响，因而广泛应用于心功能的整体评估[4]。……