左向右分流型先天性心脏病患儿心脏结构和功能改变与骨龄指数的相关性

Correlation between the changes in structure and function of cardiovascular and bone age index in children with left to right shunt congenital heart disease

目的探讨左向右分流型先天性心脏病(CHD),包括房间隔缺损(ASD)、室间隔缺损(VSD)、动脉导管未闭(PDA)患儿的骨龄变化以及心脏结构和功能改变与骨龄指数(BAI)的相关性。方法收集确诊左向右分流型CHD共130例,其中ASD 52例、VSD 46例、PDA 32例,超声检测各项心脏结构和功能指标,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,对比分析各组骨龄以及CHD各项心脏结构和功能指标与BAI的直线相关性。结果 ASD、VSD与PDA患儿BAI的差异有统计学意义(P<0.05);PDA组的BAI分别高于ASD组和VSD组,差异均有统计学意义(P均<0.05)。无PAH、轻度PAH以及中重度PAH三组的BAI分别为(0.84±0.09)、(0.75±0.07)和(0.65±0.08),差异有统计学意义(F=27.77,P=0.000);小缺损组的BAI为(0.82±0.09),高于中大缺损组的(0.73±0.10),差异有统计学意义(t=3.54,P=0.002)。ASD、VSD患儿缺损大小(DS)与BAI均呈负相关(r=-0.48、-0.54,P均<0.05);ASD、VSD、PDA患儿肺动脉收缩压(PASP)以及肺循环血流量/体循环血流量比值(Qp/Qs)均与BAI呈负相关(r=-0.64^-0.38,P均<0.05)。结论左向右分流型CHD患儿的骨龄及BAI均显著落后于正常同龄儿童;左向右分流型CHD患儿骨龄落后程度与PASP、DS及分流量大小相关。

Objective To investigate the changes in bone age, and the correlation between the changes in structure and function of cardiovascular and bone age index in children with left to right shunt congenital heart disease （CHD） such as atrial septal defect （ASD）, ventricular septal defect （VSD） and patent ductus arteriosus （PDA）. Methods One hundred and thirty children diagnosed CHD had been enrolled, including 52 cases of ASD, 46 cases of VSD and 32 cases of PDA. The cardiac structure and function indicators had been detected by ultrasonic. The anteroposterior iflm of left hand and wrist had been taken. The bone age had been assessed according to“China children bone age score”atlas, and the bone age index （BAI） had been calculated. The differences of bone age among each group had been compared. The linear correlation of the cardiac structure and function indicators with BAI had been analyzed. Results The BAI was statistically different among ASD, VSD and PDA groups （P〈0.05）. The BAI of PDA group was higher than those of ASD and VSD groups （all P〈0.05）. The BAI was also statistically different among the groups with different pulmonary artery pressures （P=0.000）. The BAI was higher in small defect size group than that in large defect size group （P=0.002）. The defect size was negatively correlated with BAI in both ASD and VSD groups （r=-0.48, -0.54, all P〈0.05）, The pulmonary artery systolic pressure and pulmonary-to-systemic blood lfow ratio （QP/QS） were negatively correlated with BAI in ASD, VSD and PDA groups （r=-0.64--0.38,all P〈0.05）. Conclusion The bone age and BAI of children with left to right shunt CHD are signiifcantly lower than those of healthy children of the same age . The extent of bone age delay is related with PASP, defect size and shunt volume in children with left to right shunt CHD.