超声斑点追踪技术评价手足口病患儿左心室局部收缩功能

Speckle tracking echocardiography in evaluation of the regional left ventricular systolic function in children with hand-foot-mouth disease

目的应用二维斑点追踪技术评价重症手足口病患儿左心室局部收缩功能。方法收集危重症手足口病患儿28例(重症组)、轻症手足口病患儿30例(轻症组)、同期年龄及性别匹配体检儿童30名(对照组)。应用二维斑点追踪技术检测重症组、轻症组及对照组左心室17个节段的收缩期长轴峰值应变、双平面Simpson法检测左心室射血分数,比较重症组、轻症组与对照组临床及血清学检查结果。结果重症组心率增快,白细胞总数、血糖及肌酸磷酸激酶心肌同工酶升高,左心室射血分数减低,与轻症组及对照组比较差异有统计学意义(P<0.05);轻症组仅见下壁基底段及中间段收缩期峰值应变减低,与对照组比较差异有统计学意义(P<0.05);重症组左心室后壁基底段及中间段、侧壁中间段收缩期峰值应变减低,与轻症组及对照组比较差异有统计学意义(P<0.05);侧壁基底段收缩期峰值应变减低,与轻症组及对照组比较差异有统计学意义(P<0.01);侧壁心尖段收缩期峰值应变减低,与对照组比较差异有统计学意义(P<0.05)。结论重症手足口病患儿存在明显局部及整体收缩功能减低。轻症手足口病患儿尽管整体收缩功能正常,但可见个别节段局部收缩功能异常。超声斑点追踪技术可检测左心室局部收缩功能,可为轻症患儿的心脏受累的早期诊断及重症手足口病患儿病情进展和预后评价提供帮助。

Objective To evaluate the regional left ventricular systolic function in patients with hand-foot-mouth disease（HFMD） with speckle tracking echocardiography.Methods High frame rate two-dimensional images were recorded from the left ventricular long-axis view in 28 patients with severe HFMD（severe group）,30 patients with mild HFMD（mild group） and 30 healthy children（control group）.The longitudinal strain was measured in the apical view.The left ventricular ejection fraction（LVEF） was measured with 2D echocardiography.Clinical and serum results were compared among three groups.Results Compared with mild group and control group,the heart rate elevated,WBC,glucose level and CK-MB isoenzyme increased,LVEF decreased in severe group（P0.05）.The middle longitudinal strain and basal longitudinal strain of left ventricular inferior wall in mild group were lower than that in control group（P0.05）.Compared with mild group and control group,the middle longitudinal strain and basal longitudinal strain of left ventricular posterior wall and the middle longitudinal strain of left ventricular lateral wall significantly decreased in severe group（P0.05）.The basal longitudinal strain of left ventricular lateral wall in severe group was lower than mild group and control group（P0.01）.The apical longitudinal strain of left ventricular lateral wall in severe group was lower than that of control group（P0.05）.Conclusion The regional left ventricular longitudinal systolic function and the left ventricular global systolic function in patients with severe HFMD are impaired.The global systolic function in mild HFMD patients is normal,but the individual segments of regional left ventricular longitudinal systolic is of dysfunction.The speckle tracking echocardiography can be used to assess the regional left ventricular longitudinal systolic function in patients with HFMD.It is benefit for early diagnosis of cardiac involvement in mild cases and evaluation of progression and prognosis in severe cases.