组织多普勒成像技术诊断川崎病患儿30例心功能研究

Clinical value of tissue Doppler imaging in the evaluation of 30 Kawaski disease children's heart function

目的:通过组织多普勒成像技术(TDI)探讨川崎病(KD)患儿的心功能障碍,为临床治疗和判断预后提供依据。方法:应用TDI检测川崎病患儿左心室舒张末期内径(LVED)、左室射血分数(LVEF)、舒张期二尖瓣血流频谱(包括舒张早期快速充盈峰速E峰和舒张晚期快速充盈峰速A峰),计算E/A值;TDI检测二尖瓣环6个位点的收缩峰值速度S、舒张早期峰值速度e和舒张晚期峰值速度a,并取平均值,计算e/a、E/e值,判断心功能,20例同期正常体检儿童为对照组。结果:川崎病患儿急性期,患儿心功能减低,以舒张功能减低为主。比较KD组与正常对照组,LVED升高(P<0.05),LVEF无差异(P>0.05),E/A值显著降低(P<0.01);TDI显像结果,S峰及e峰显著降低(P<0.01),a峰升高(P<0.05),e/a值显著降低(P<0.01),E/e值显著升高(P<0.01)。结论:KD急性期存在心功能减低,且左室舒张功能减低较左室收缩功能减低明显,TDI检测能较好反应KD患儿左心功能变化。

Objective：To evaluate the cardiac function of children with Kawasaki disease （KD） by tissue Doppler image （TDI） so as to find a new helpful indicator for diagnosis and prognosis of KD. Methods：Left ventricular end diastolic diameter （LVED）,left ventricular ejection fraction （LVEF）,peak early mitral diastolic filling velocity （E）,peak late mitral diastolic filling velocity （A） and the ratio of （E/A） at the mitral valve blood flow spectrum in diastolic phase in KD patients were measured by ultrasonic cardiogram routinely. Tissue Doppler image indexes included systolic velocity （Vs）,early diastolic peak velocity （e wave）,late diastolic peak velocity （a wave） and the ratio of e/a. Six points in each patient were selected to calculate average value of each index. 20 healthy infants and children were recruited as control. Results：It is showed the decline of cardiac function in KD patients at acute stage,especially obvious in diastolic phase. The values of LVED,a wave and the ratio of E/e in KD patients were significantly higher than those in control group （P0. 05）,but no significant difference in LVEF. However the levels of the ratios of （E/A） and e/a,e wave and Vs in KD patients were very significantly lower than those in control group （P0.05）. Conclusion：The cardiac function damage often occurs in KD patients at acute stage and the decline of left ventricle diastolic function can be found more commonly than that of systolic function. Therefore TDI indexes may be very useful to reflect left cardiac function in children with KD.