瞬时弹性成像技术检测肝脏硬度评价左心辅助装置植入患者术后不良事件

Liver stiffness detection by transient elastography in evaluation of major adverse events in patients after left ventricular assist device implantation

摘要:

目的  探究瞬时弹性成像技术检测肝脏硬度评价严重心力衰竭患者左心辅助装置植入后不良事件发生的可行性。方法  选取于河北省沧州市中心医院行左心辅助装置移植的患者56例作为研究对象。并根据术后是否发生不良事件分为事件组和非事件组。术前对所有患者进行常规血检和心脏功能检验，使用FibroScan检测患者的肝脏硬度。SPSS 19.0统计软件进行logistics回归分析患者术后不良事件发生的危险因素，并通过绘制ROC曲线评价肝脏硬度判断术后不良事件的准确性。结果  术前事件组肝脏硬度高于非事件组，术后1周两组患者的肝脏硬度较术前均有下降，且事件组患者的肝脏硬度仍高于非事件组（P <0.05）；术后4周两组患者的肝脏硬度均有大幅度降低，与术前比较差异有统计学意义（P <0.05），且术后4周事件组和非事件组患者的肝脏硬度差异无统计学意义（P >0.05）。Logistics回归分析显示肝脏硬度是术后不良事件的危险因素，ROC曲线下面积为0.853，敏感性为0.826，特异性为0.736。结论  肝脏硬度是左心辅助装置移植手术患者术后不良事件发生的危险因素，瞬时弹性成像技术可作为一种无创检测手段用于患者左心辅助装置移植术前检查，辅助判断患者心力衰竭的严重程度，预测术后不良事件的发生情况。

Abstract:

Objective To evaluate the feasibility of evaluating the major adverse events by liver stiffness using transient elastography in patients after left ventricular assist device implantation. Methods Fifty-six patients who underwent left ventricular assist device implantation were included in our study, and divided into events group and non-events group according to the presence of major adverse events or not. Blood examination and heart function test were performed before operation. FibroScan was used to check the liver stiffness before and after operation. SPSS 19.0 was used to analyze the risk factors for postoperative adverse events, and ROC curve was used to analyze the veracity of the method. Results The liver stiffness of the events group was higher than that of the non-events group (P < 0.05); the liver stiffness was lowered 1 week after operation, which was still lower in the non-events group than in the events group (P < 0.05). Four weeks after operation, the liver stiffness lowered in both groups and was still significantly different from the preoperative one (P < 0.05), but there was no significant difference between the two groups (P > 0.05). Logistic regression analysis showed liver stiffness is a risk factor of the major adverse events after left ventricular assist device implantation, and ROC curve showed the area under curve was 0.853, the sensitivity was 0.826 and the specificity was 0.736. Conclusions Liver stiffness is a risk factor of postoperative adverse events after left ventricular assist device implantation operation. Transient elastography can be used as a non-invasive detection method before left ventricular assist device implantation operation, to help verify the severity of the disease and forecast the occurrence of major adverse events.