慢型克山病彩色多普勒超声心动图分析

Analysis of color doppler ultrasonography of chronic Keshan disease

目的 观察慢型克山病的彩色多普勒超声心动图改变,为临床诊断提供依据.方法 2009年9-11月,依据〈克山病诊断标准〉（GB 17021-1997）,在山东省克山病病区邹城市、泗水县、沂水县、五莲县、莒县和平邑县选择64例慢型克山病患者作为病例组,在济南市地方病研究所选择34例健康志愿者作为对照组,对所有调查对象进行彩色多普勒超声检查,测量心脏结构指标、左室收缩功能及舒张功能指标.结果 克山病组的左房内径、左室舒张末期内径、左室收缩未期内径、右室内径、主动脉内径、右房横径、右房长径、左室重量[（35.38±6.89）、（61.57±8.61）、（45.39±10.29）、（17.22±3.79）、（28.69±2.81）、（38.00±6.05）、（42.68±8.65）mm、（283.22±103.12）g]均高于对照组[（26.70±3.27）、（45.41±4.93）、（26.91±4.35）、（13.76±2.27）、（24.09±2.89）、（31.50±3.32）、（35.82±3.14）mm、（156.03±39.86）g,t值分别为6.93、10.09、9.98、4.87、7.64、5.81、4.46、6.90,P均＜0.05].克山病组左室射血分数、左室短轴缩短率[（49.25±14.33）%、（26.11±9.17）%]均低于对照组[（73.88±4.04）%、（42.88±3.62）%,t值分别为-9.79、-10.23,P均＜0.05].95%（61/64）克山病患者室壁呈弥漫性运动减弱,5%（3/64）患者室壁节段性运动不良.克山病组二尖瓣返流检出率达75%（48/64）,三尖瓣返流检出率达39%（26/64）,对照组未发现有意义瓣膜返流.结论 慢型克山病房室腔径增大、心脏增重、室壁呈弥漫性运动减弱,并节段性运动不良,心功能降低,二尖瓣返流较三尖瓣严重.超声心动图对慢型克山病的判断有重要意义.

Objective Color doppler ultrasonography of chronic Keshan disease （CKD） was evaluated to provide evidences for clinic diagnosis of the disease. Methods From September to Novermber 2009, according to ＂Diagnostic criteria of Keshan disease＂ （GB 17021-1997）, 64 cases of CKD were randomly sampled from five Keshan diseased districts in Shandong province, Zoucheng, Sishui, Yishui, Wulian, Jvxian, and Pingyi as patient group. Thirty four healthy volunteers being checked up by Shandong Institute for Endemic Diseases Control and Research were put in control group. All the subjects were examined with Color doppler ultrasonography. The indexes of cardiac structure, left ventricular （LV） systolic function and LV diastolic function were measured.Results Left atrial internal diameter, LV end-diastolic internal diameter, LV end-systolic internal diameter, right ventricular diameter, aorta diameter, right atrial transverse diameter, right atrial long diameter and left ventricle mass of the patient group[（35.38 ± 6.89）, （61.57 ± 8.61）, （45.39 ± 10.29）, （17.22 ± 3.79）, （28.69 ± 2.81）,（38.00 ± 6.05）, （42.68 ± 8.65）mm, （283.22 ± 103.12）g] were higher than that of control group[（26.70 ± 3.27）,（45.41 ± 4.93）, （26.91 ± 4.35）, （13.76 ± 2.27）, （24.09 ± 2.89）, （31.50 ± 3.32）, （35.82 ± 3.14） mm, （156.03 ±39.86）g, t = 6.93, 10.09, 9.98, 4.87, 7.64, 5.81, 4.46, 6.90, all P〈 0.05]. The LV ejection fraction and fractional shortening of the left ventricular of the patient group[（49.25 ± 14.33）%, （26.11 ± 9.17）%] were lower than that of control group[（73.88 ± 4.04）%, （42.88 ± 3.62）%, t = - 9.79, - 10.22, all P〈 0.05]. Diffuse hypokinetic motion of the left ventricle reduced in 95% （61/64） of CKD patients, and 5% （3/64） of CKD patients had segmental LV dyskinesia. Seventy five per sent（48/64） of the patients accompanied with mitral regurgitation, and 39% （26/64） of these cases accompanied with tricuspid regurgitation. Meaningful Mitral or tricuspid regurgitation was not found out in control group. Conclusions The CKD patients＇ bore of atrio-ventricular cavity and LV mass are enlarged, and their motion of ventricle is reduced or partly reduced. They have poor heart function. Mitral regurgitation are more than tricuspid regurgitation. Color doppler Ultrasonography is important in diagnosis of chronic Keshan discase.