多巴酚丁胺负荷超声心动图评价小儿心脏β-受体反应性

Evaluation of cardiac betaadrenergic receptor responsiveness in children by dobutamine stress echocardiography

目的研究小儿心脏β受体（βＡＲ）功能和反应性。方法采用多巴酚丁胺负荷超声心动图（ＤＳＥ），对３０例βＡＲ功能亢进症、１５例扩张型心肌病患儿和３０例正常对照小儿的心脏左心室射血分数（ＥＦ）、短轴缩短率（ＦＳ）、左心室收缩末期容量指数（ＥＳＶＩ）、收缩压和左心室收缩末期容量指数比值（ＳＰ／ＥＳＶＩ）及左心室后壁增厚率（△ＰＷＴ％）等进行测定。结果药物负荷前，βＡＲ功能亢进组儿童的ＳＰ／ＥＳＶＩ和ΔＰＷＩ％高于对照组小儿（Ｐ＜０．０５），扩张性心肌病组ＥＦ，ＦＳ，ＳＰ／ＥＳＶＩ和ΔＰＷＴ％低于正常对照组，而ＥＳＶＩ大于正常对照组（Ｐ＜００５）；药物负荷后，βＡＲ功能亢进组ＥＦ由用药前０７２增加至０８４，ＦＳ由用药前的０３９增加至０５１，ＳＰ／ＥＳＶＩ由５７增加至１０８，ΔＰＷＴ％由８０％增加至８９％，正常对照组ＥＦ由用药前０７０增加至０７６，ＦＳ由用药前０３５增加至０４１，ＳＰ／ＥＳＶＩ由５０增加至６９，ΔＰＷＴ％由６８％增加至８１％（Ｐ＜００５），而扩张性心肌病组患儿上述指标无明显增加（Ｐ＞００５）。结论多巴酚丁胺负荷试验可以客观地反映心脏βＡＲ功能和反应性。

Objective To evaluate cardiac betaadrenergic receptor (AR) function and responsiveness in children Methods Left ventricular ejection fraction (ET), percent age of fractional shortening (FS), left ventricular end systolic volume index (ESVI), ratio of systolic blood pressure and left ventricular end systolic volume index (SP/ESVI) and change of left ventricular posterior wall thickness (PWT%) etc in 30 children withAR hypersensitivity, 15 children with dilated cardiomyopathy and 30 normal children were measured by dobutamine stress echocardiography (DSE) Results Before the pharmacological stress, the values of SP/ESVI and PWT% were higher in AR hypersensitivity group (P<005), and EF, FS, SP/ESVI and PWT% were lower and ESVI was higher in dilated cardiomyopathy group (P<005) compared with those in controls After the pharmacological stress, EF increased to 084 from 072, FS to 051 from 039, SP/ESVI to 108 from 57, PWT% to 89% from 80% in AR hypersensitivity group, EF increased to 076 from 070, FS to 041 from 035, SP/ESVI to 69 from 50, PWT% to 81% from 68% in control groups (P<005), while those values in dilated cardiomyopathy group changed little (P>005) Conclusion DSE might be used to evaluate cardiac AR function and responsiveness in children