儿童超声心动图冠状动脉正常参考值及临床意义

Normal reference values of coronary artery on echocardiography in healthy Chinese children

目的探讨建立儿童超声心动图冠状动脉正常参考值及其临床意义。方法对400例出生1个月至12岁的健康儿童进行超声心动图检查,其中男232例、女168例。检测冠状动脉(LCA、LAD、pRCA、mRCA、dRCA)内径和左冠状动脉前降支舒张期峰值流速(LAD-Vmax),分析其与体表面积(BSA)、左心室心肌质量(LVmass)和主动脉瓣环内径(ARD)的相关性。结果男性儿童的BSA、LVmass、LAD-Vmax、LCA、LAD、pRCA、mRCA、dRCA分别为(0.60±0.25)m2、(28.85±14.16)g、(26.04±4.24)m/s、(2.27±0.36)mm、(1.85±0.32)mm、(1.87±0.34)mm、(1.77±0.31)mm、(1.69±0.32)mm,大于女性儿童的(0.58±0.26)m2、(27.55±14.06)g、(25.46±4.13)m/s、(2.19±0.34)mm、(1.80±0.32)mm、(1.83±0.35)mm、(1.76±0.33)mm、(1.68±0.31)mm,但差异均无统计学意义(t=0.577、0.799、1.043、1.913、1.850、0.853、0.236、0.166,P均>0.05)。LCA、LAD、pRCA、mRCA、dRCA内径随年龄增长而增大(F=147.93、101.56、124.39、190.74、149.68,P均<0.05)。LCA、LAD、pRCA、mRCA、dRCA内径随BSA增大而增大,呈异方差性正相关(r=0.896、0.852、0.877、0.914、0.917,P均<0.05)。LCA、LAD、pRCA、mRCA、dRCA内径均与LVmass呈正相关(r=0.821、0.779、0.798、0.857、0.855,P均<0.05)。LCA、LAD、pRCA、mRCA、dRCA内径均与ARD呈正相关(r=0.814、0.768、0.782、0.814、0.817,P均<0.05)。冠脉比值LCA/ARD、LAD/ARD、pRCA/ARD、mRCA/ARD、dRCA/ARD均随BSA增大而明显减小。LAD-Vmax随BSA有增加趋势,但无相关性(r=0.023,P>0.05)。结论健康儿童冠状动脉内径与年龄、BSA之间有一定相关性。应用BSA、LVmass及冠状动脉比值等回归方程,计算标准化的Z值,有助于客观定量冠状动脉扩张,诊断儿童冠状动脉病变,值得在临床推广应用。

Objective To investigate the normal reference values of coronary arteries in healthy Chinese infants and childrenon echocardiography and the clinical significance.Methods Echocardiography data from 400 normal pediatric subjects(age:1 month to 12 years old.male:232;female:168)in Shenzhen Children's Hospital were retrospectively analyzed.The height,weight and body surface area(BSA)of every subject were measured.The parameters of echocardiography were measured as follows:the diameters of left coronary artery(LCA),left artery descending(LAD),proximal right coronary artery(pRCA),middle of right coronary artery(mRCA),distal right coronary artery(dRCA);the diastolic maximum velocity of LAD(LAD-Vmax);the diastolic left ventricle mass(LV mass);and aortic ring diameter(ARD).The gender difference in all parameters was studied.The relationship between coronary diameters and BSA,LV mass and ARD were analysed.And the relationship between the LAD-Vmax and BSA was also analyzed.Results The following parameters were higher in male than female:BSA(0.60±0.25)m2 vs(0.58±0.26)m2;LV mass(28.85±14.16)g vs(27.55±14.06)g;LCA(2.27±0.36)mm vs(2.19±0.34)mm;LAD(1.85±0.32)mm vs(1.80±0.32)mm;pRCA(1.87±0.34)mm vs(1.83±0.35)mm;mRCA(1.77±0.31)mm vs(1.76±0.33)mm;dRCA(1.69±0.32)mm vs(1.68±0.31)mm;and LAD-Vmax(26.04±4.24)m/s vs(25.46±4.13)m/s.But the differences were not statistically significant(t=0.577,0.799,1.043,1.913,1.850,0.853,0.236,0.166 all P>0.05).The age showed positive correlations with BSA(r=0.78,P<0.05) and LV mass(r= 0.514,P<0.05),but a negative correlation with heart rate(r=-0.739,P<0.05).With age increasing,the coronary diameters of LCA,LAD,pRCA,mRCA,and dRCA increased(F=147.93,101.56,124.39,190.74,149.68,all P<0.05).The coronary diameters were significantly correlated with BSA(P<0.05),LV mass(P<0.05) and ARD(P<0.05).The correlation coefficients of coronary diameters(including LCA,LAD,pRCA,mRCA,dRCA) with BSA as r=0.896,0.852,0.877,0.914,0.917;with LV mass as r=0.821,0.779,0.798,0.857,0.855;and with ARD as r=0.814,0.768,0.782,0.814,0.817,respectively.The coronary artery to ARD ratio(including LCA/ARD、LAD/ARD、pRCA/ARD、mRCA/ARD、dRCA/ARD)reduced significantly when BSA increased.The LAD-Vmax also increased with BSA increasing without statistical significance(r=0.023,P>0.05).Conclusions There are correlations between coronary diameters and age and BSA in the healthy infants and children.And there is a heterogeneous distribution of the measurements of echocardiography.The normal value of coronary artery may be predicted by the regression analysis with BSA,LVmass and coronary artery to ARD ratio.The regression equations and Z-score can be useful for the objective determination of abnormal coronary size,which is important in diagnosis of the pediatric coronary disease.