超声心动图观察急性肾小球肾炎冠状动脉病变

Pathologic changes of coronary artery in patients with acute glomerular nephritis observed by echocardiogram

目的 使用超声心动图动态观察急性肾小球肾炎时冠状动脉内径的变化 ,分析引起冠状动脉扩张的原因。方法 16 0例急性肾小球肾炎患儿中检出冠状动脉扩张32例 ,男 2 2例 ,女 10例 ;年龄 5 .6～ 13a,平均 8.5a。使用Acuson12 8彩超仪 ,于急性期及恢复期分别检测 2次。检测参数 :左室内径、主动脉根部内径、左右冠状动脉起始部内径、计算冠状动脉内径与主动脉根部内径的比值 (冠状动脉 主动脉 )。结果 急性期 32例冠状动脉内径 3～ 5 .6mm ,平均 3.5mm ;冠状动脉 主动脉比值为 0 .2 0～ 0 .2 8,平均 0 .2 1;左室内径不同程度扩大。恢复期各项参数基本恢复正常。结论 进行肾小球肾炎的冠状动脉扩张可能是一种代偿机制 ,但尚不能除外冠状动脉本身的病理改变。

Objective To observe the changes of diameter of coronary artery(CA)dynamically in acute glomerular nephritis and to analyze the resons of CA dilation with echocardiogram. Methods Among 160 children with acute glomerular nephritis, there were 32 cases with CA dilation (22 females and 10 males).The age ranged from 5.6 years to 13 years,mean age 8.5 years.Each case was detected twice with Acuson 128 color ultrasonograph in acute stage and in restoration stage respectively. The detection parameter included diameter of left ventricle,diameter of aorta,diameter of left and right CA,the ratio of diameter of coronary artery and aorta. Result In acute stage,the diameter of coronary artery ranged from 3～5.6 mm, mean value 3.5 mm;the ratio ranged from 0.20～0.28,mean value 0.21.The enlargement of diameter of left ventricle was detected.Each parameter basically returned to normal value in restoration stage. Conclusion Serious circular congestion in acute glomerular nephritis can result in the increase in stroke value, the enhancement of myocardial contraction force and the increase in oxygen consumption of myocardium.Coronary artery is the nutritional vessels of the heart and is controlled by sympathetic nerves and vagus nerves.When the oxygen consumption of myocardium increases,the sympathetic nerves will be excited,which results in dilation of CA.It can be concluded that CAdialtion in acute glomerular nephritis might be a kind of compensatory mechanism,but the possibility of pathologic changes of CA itself couldnot be excluded.