儿童先天性房间隔缺损心脏结构和功能与骨龄改变的相关性研究

Correlation between the changes in cardiac structure and function and bone age in children with congenital at- rial septal defect

目的探讨先天性房间隔缺损（ASD）患儿体格、骨龄变化及心脏结构和功能改变与骨龄指数（BAI）的相关性。方法确诊ASD患儿48例为实验组，健康体检儿童30例为健康对照组，2组均测量身高、体质量。采用Philipsie33型超声诊断仪检测各项心脏结构和功能指标，Philips数字x光机摄左手及腕关节正位片，应用最新《中国儿童骨龄评分法》图谱进行骨龄评定，并计算BAI。14例行ASD修补术的ASD患儿术中测量缺损口面积。分析实验组与对照组儿童体格发育及骨龄的差异，分别将实验组各项心脏结构和功能指标、缺损口面积与BAI进行直线相关性分析。结果2组年龄、身高、骨龄比较差异均无统计学意义（t：一0．02，一1．31，一1．69，P均〉0．05），体质量、BA!比较差异均有统计学意义（t=-2．28，-9．06，P均〈0．05）；不同肺动脉收缩压（PASP）ASD患儿的身高、体质量、BAI比较差异均有统计学意义（f’27．630，23．537，16．704，P均〈0．01）；不同缺损口大小的ASD患儿年龄、体质量比较差异均无统计学意义（t=-1．218，-0．046，P均〉0．05），而身高、BAI比较差异均有统计学意义（t：2．561，2．191，P均〈0．05）；ASD患儿年龄与BAI无相关性（r=-0．175，P〉0．05），缺损口大小、缺损口大小／房间隔伸展径、PASP与BAI均呈负相关（r=-0．349，P〈0．05；r=-0．412，P〈0．01；r=-0．539，P〈0．01）；14例ASD患儿缺损口面积与缺损口大小呈正相关（r=0．599，P〈0．05），与BAI呈负相关（r=-0．655，P〈0．05）。结论ASD患儿体格发育落后于正常儿童，以体质量落后明显；ASD患儿BAI亦显著落后于正常儿童，即骨骼生长速率显著落后于正常同龄儿；ASD患儿体格发育及骨龄落后程度与PASP、缺损口大小相关；PASP对身高影响较大，缺损口大小对身高、体质量均有影响；实际年龄即病程长短与体格发育及骨龄无相关性。

Objective To investigate the changes in physique and the bone age,and the correlation between the changes in cardiac structure and function and the bone age index （BAI） in atrial septal defect （ ASD ） children. Methods The experimental group included 48 cases of ASD patients,and 30 cases of healthy children were assigned as the control group;the children of both groups were measured for height and weight. Philips ie33 ultrasonic detector was used to detect the indicators of cardiac structure and function, and Philips digital X-ray machine was used to radio- graph the left hand and the wrist. Then the bone age was assessed in order to calculate the BAI. Fourteen cases of ASD patients who underwent repairing surgery were measured for orifice area in surgery. The differences in physique and the bone age between the 2 groups were analyzed, and Pearson correlation analysis method was used to observe the correla- tion between the cardiac structure and function indicators, defect area and BAI in the experimental group. Results There was no significant difference in the age,height,bone age（t = -0.02, -1.31, -1.69,all P 〉0.05） ,while the weight and BAI were significantly different between the 2 groups （ t = - 2.28, - 9.06, all P 〈 0.05 ）. The height, weight and BAI were significantly different in different pulmonary artery systolic pressure （PASP） patients （ F = 27. 630, 23. 537,16.704, all P 〈 O. 01 ）, while the age and weight had no difference （t = -1. 218, -O. 046, all P 〉 0.05 ）. The height and BAI were significantly different in patients with different defect size（ t = 2. 561,2. 191,all P 〈 0.05 ）. There was no correlation between the age and the BAI in children with ASD（ r = - 0. 175 ,P 〉 0.05）. The defect size, defect size/atrial septal stretched diameter, PASP were all negatively correlated with BAI （ r = - 0. 349, P 〈 0.05 ; r = - 0.412, P 〈 0.01 ;r = - 0. 539, P 〈 0. 01 ）. The defect area was positively related to the defect size in 14 cases of chil- dren with ASD underwent surgery（ r = 0. 599, P 〈 0.05 ）, and the defect area was negatively correlated with BAI （r = - O. 655,P 〈 O. 05 ）. Conclusions The physical development in ASD patients evidently lagged behind the healthy children, particularly for weight. The BAI of ASD patients is significantly smaller than that of the healthy children, in other words, the growing speed of bone in ASD patients is significantly slower than that of the healthy children at the same age. The lagging extent of physical development and the bone age are related to the PASP and defect size. PASP has more influence on the height,yet the defect size has influence on height and weight of ASD children. There is no correlation between physical development and the bone age with the course of disease.