用于评估先天性心脏病中心静脉压的肝脏硬度测量
Liver stiffness measurements for evaluation of central venous pressure in congenital heart diseases.
作者信息
Jalal Zakaria, Iriart Xavier, De Lédinghen Victor, Barnetche Thomas, Hiriart Jean-Baptiste, Vergniol Julien, Foucher Juliette, Thambo Jean-Benoit
机构信息
Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France.
Department of Hepatology and Gastroenterology, University Hospital of Bordeaux, Pessac, France INSERM 1053, Université Bordeaux, Bordeaux, France.
出版信息
Heart. 2015 Sep;101(18):1499-504. doi: 10.1136/heartjnl-2014-307385. Epub 2015 Jun 17.
OBJECTIVE
Transient elastography (TE; Fibroscan, Echosens, France) is a non-invasive and reproducible approach to assess liver stiffness (LS). LS has been reported to be associated with fibrosis but central venous pressure (CVP) can also influence LS values. We sought to evaluate the correlation between LS and CVP in a large cohort of children and adults with congenital heart disease.
METHODS
All patients referred in our institution between 2012 and 2013 for diagnostic or interventional right heart catheterisation (RHC) were prospectively enrolled excluding patients with acute heart failure, chronic alcohol abuse, chronic liver disease, severe obesity and ascites. Patients underwent LS measurement and CVP measurement by RHC under general anaesthesia within the same or subsequent day.
RESULTS
Sixty children (7.4±5.5 years) and 36 adults (38±16 years) were included. Median CVP was 6 mm Hg (range 3-15), median LS was 5 kPa (range 2.8-47.2). LS significantly correlated with CVP (r=0.75, p<10(-4)). In the two subgroups (ie, children and adults), correlation was r=0.68 and r=0.84 (p<10(-4)), respectively. In the overall population, the area under the curve of LS for identification of CVP >10 mm Hg was 0.972 (95% CI 0.855 to 1; p<0.05). Optimal cut-off value of LS for detection of CVP >10 mm Hg was 8.8 kPa (sensitivity=91.67%, specificity=96.25%).
CONCLUSIONS
LS measurement using TE is a rapid and reliable method to evaluate CVP in patients with congenital heart disease.
目的
瞬时弹性成像（TE；Fibroscan，法国Echosens公司）是一种评估肝脏硬度（LS）的无创且可重复的方法。据报道，LS与肝纤维化有关，但中心静脉压（CVP）也会影响LS值。我们试图在一大群先天性心脏病儿童和成人中评估LS与CVP之间的相关性。
方法
前瞻性纳入2012年至2013年间在我们机构因诊断性或介入性右心导管检查（RHC）就诊的所有患者，但排除患有急性心力衰竭、慢性酒精滥用、慢性肝病、严重肥胖和腹水的患者。患者在全身麻醉下于同一天或随后一天接受RHC测量CVP以及LS测量。
结果
纳入60名儿童（7.4±5.5岁）和36名成人（38±16岁）。CVP中位数为6 mmHg（范围3 - 15），LS中位数为5 kPa（范围2.8 - 47.2）。LS与CVP显著相关（r = 0.75，p < 10⁻⁴）。在两个亚组（即儿童和成人）中，相关性分别为r = 0.68和r = 0.84（p < 10⁻⁴）。在总体人群中，用于识别CVP > 10 mmHg的LS曲线下面积为0.972（95%CI 0.855至1；p < 0.05）。检测CVP > 10 mmHg的LS最佳截断值为8.8 kPa（敏感性 = 91.67%，特异性 = 96.25%）。
结论
使用TE测量LS是评估先天性心脏病患者CVP的一种快速且可靠的方法。
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