先天性甲状腺功能减退症患儿心功能改变及意义

Alteration and meaning of heart function in patients with congenital hypothyroidism

为探讨先天性甲状腺功能减退症 (CH)患儿心功能改变及临床意义 ,对 2 0例 CH患儿和年龄、性别配对的 2 0例正常儿童 ,采用多普勒组织显像 (DTI)测量其二尖瓣环收缩期及舒张早期运动速度 (MVR- SV及MVR- De V )、左室后壁心内膜收缩期及舒张期运动速度 (L VPW- En SV及 L VPW- En DV ) ,传统超声心动图(U CG)测量其心脏各腔室大小、左室心肌重量指数 (L VMI)、心脏每搏指数 (SI)、射血分数 (EF)、二尖瓣舒张早期血流峰值 (E峰 )、舒张晚期血流峰值 (A峰 ) ,以及心电图、心肌酶。结果显示 ,观察组治疗前均有心电图、心肌酶异常 ,UCG示心腔扩大、心肌重量增加、心包积液等 ,DTI示心肌收缩期和舒张期运动速度显著降低 ,MVR- De V及 L VPW- En DV显著降低 ,其异常率显著高于传统心功能指标 ;L VMI 75 %显著增高。经甲状腺激素替代治疗后多于 2～ 12周恢复正常。认为 CH易并发心脏病变 ;DTI为了解 CH心脏病变程度敏感而实用的方法 ;

To assess the alteration and clinical meaning of heart function in patients with congenital hypothyroidism(CH).The systolic and diastolic early velocities of mitral valvular ring(MVR SV and MVR DeV),endocardial systolic and diastolic velocities of left ventricular posterior wall(LVPW EnSV and LVPW EnDV) were measured by DTI.Left atrial(LA),left ventricular systolic and diasolic volume index(LVsVI and LVdVI),left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF),stroke volume index(SI),transmitral early(E) and late(A) flow velocity peak,and E/A measured by conventional ultrasonic cardiogram(UCG).Cardiac enzyme and electrocardiogram were also examed in 20 patients with CH and 20 nomal children whose age and sex were similar to CH group.Results showed that the MVR SV,MVR DeV,LVPW EnSV,LVPW EnDV,E and E/A were signifcantly lower and the LA,LCsVI,LVdVI and LVI were significantly higher in CH group unteated than those in nomal subjects.The MVR DeV was significantly sensitive than conventional indictors.The cardiac function recovered after the start of levo thyroxine 2～12 weeks in patients with CH.Thus consider that cardiac lesion easily involved in patients with CH,DTI provide a sensitive and reliable method for estimate left ventricular function in patients with CH.The cardiac function recover within 2～12 weeks after the levothyroxnie therapy in earlier in patients with CH