舒张早期室间隔异常振动对缩窄性心包炎的诊断价值

Value of exceptional early diastolic ventricular septal vibration on detection of constrictive pericarditis

目的探讨超声心动图舒张早期室间隔异常振动对缩窄性心包炎(CPC)尤其是非典型CPC的诊断价值。方法选择确诊的CPC患者33例(CPC组),并与性别、年龄匹配的30例慢性心力衰竭患者(CHF组)及30例正常人(CTL组)作对照。应用M型及二维超声心动图观察舒张早期室间隔异常振动的发生率、振动次数、震动幅度及呼吸对其的影响。结果 CPC组舒张早期室间隔异常振动的发生率在平静及深吸气时分别为88%和76%(P<0.05),振动次数分别为(3.0±0.9)次和(1.1±0.6)次(P<0.01),最大振动幅度分别为(2.3±0.5)mm和(1.3±0.6)mm(P<0.01),CHF组和CTL组在平静及深吸气时均未检出舒张早期室间隔异常振动。在典型(15例)和非典型(18例)CPC亚组中,平静呼吸时舒张早期室间隔异常振动的发生率分别为100%和78%(P>0.05),深呼吸时分别为100%和67%(P<0.05)。结论舒张期早期室间隔异常振动是CPC一项敏感和特异性较高的间接超声征象,结合直接征象和其他间接征象及呼吸对其的影响,该征象对CPC尤其非典型患者具有重要的诊断价值。

Objective To explore the diagnostic value of echocardiography-derived exceptional early diastolic ventricular septal vibration （DSV） on the detection of chronic constrictive pericarditis （CPC）. Methods A total of 33 patients with con- firmed CPC （group CPC） and 30 patients with chronic heart failure （group CHF） and 30 normal subjects （group CTL）, who were matched at age and gender, were included in present study. M-mode and two-dimensional echocardiography were performed to assess occurrence, vibrating number per cardiac cycle, and highest amplitude of DSV respectively at normal respiration and deep inspiration with breath-holding. Results In Group CPC, respectively, at normal respiration and deep inspiration, the oc- currence of DSV was 100% and 78% （P〈0.05）, vibrating number per cardiac cycle was 3.0±0.9 and 1.1±0.6 （P〈0. 01）, highest amplitude of DSV was （2.3±0.5） mm and （1.3±0.6） mm （P〈0.01）. There was no DSV in group CHF or group CTL. In the sub-group of typical （n=lS） and non-typical （n=18） in group CPC, the occurrence of DSV was 100% and 78% at normal respiration （P〉0. 05）, 100% and 67% at deep inspiration （P〈0. 05）. Conclusion DSV is one of relatively sensitive and specific indirect echocardiographic sign of CPC, and has particular value for detection of non-typical CPC when judging with other direct and indirect echocardiographic signs.