应用二维斑点追踪超声心动图技术评估川崎病患儿心肌运动功能的相关研究

Evaluation of myocardial deformation in children with Kawasaki disease by two dimensional speckle tracking echocardiography

目的探讨二维斑点追踪超声心动图技术（speckle tracking echocardiography, STE）评估不同病程川崎病（Kawasaki disease，KD）患儿左心室心肌运动功能中的临床价值。方法91例KD患儿根据病程分为急性期组（A组）、恢复期组（B组）和慢性期组（c组）；根据KD急性期有无冠状动脉损伤分为冠脉损伤组和无冠脉损伤组；选择56例健康体检儿童作为对照组。采用二维超声心动图技术采集所有研究对象心肌动态图像，同时测量左室射血分数（left ventricular ejection fraction, LVEF）、短轴缩短率（left ventricular fractional shortening, LVFS）等常规超声心动图和组织多普勒（TDI）显像相关指标，进一步应用QLAB 9．0软件对所采集的心肌图像进行斑点追踪并获得左室心肌整体纵向应变（global longitudinal strain，GLS）、纵向应变率（global longitudinal strain rate，GLSR）和环向圆周应变（global circumferential strain，GCS）、环向圆周应变率（global circumferential strain rate，GCSR）指标，分析心肌运动情况。结果（1）常规超声指标LVEF、LVFS差异无统计学意义。（2）KD的A、C组GLS值较对照组显著降低（P〈0．01）；A、B、C组GCS和GCSR值较对照组显著降低（P〈0．01）；A、B、C三组之间的GCSR值差异有显著统计学意义（P〈0．01）。（3）KD急性期冠脉损伤组GLS、GLSR、GCS和GCSR值均较无冠脉损伤组降低（P〈0．05）。（4）TDI测量结果显示B组游离壁近二尖瓣环处舒张早期心肌运动速度较A、C组升高（P〈0．05）；A、C组室间隔近二尖瓣环收缩期心肌运动速度较对照组均降低（P〈0．05）。结论KD各阶段心肌运动功能存在不同程度损伤；KD急性期合并冠脉损伤可能影响心肌运动功能；STE对早期评估KD亚临床心功能不全具有重要临床诊断价值。

Objective To investigate and assess the diagnostic value of left ventricular myocardial de formation during different phases of Kawasaki disease （KD） by two-dimensional speckle tracking echocardiography. Methods A total of 91 patients with KD were recruited as the research group, which was divided into acute phase group （ A）, convalescent phase group （B） and chronic phase group （C）. Based on whether occuring coronary artery lesions, the acute phase group was then subdivided. Meanwhile 56 healthy subjects were recruited as control group. Two-dimensional echocardiography was applied for collecting all myocardial motion images. Left ventdcular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS） and other indexes were analyzed by traditional echocardiography and tissue Doppler image. Global longitudinal strain （GLS）, strain rate （GLSR） and circumferential strain （GCS）, strain rate （GCSR） were calculated via QLAB 9. 0 software offline. Results Firstly, no significant difference was found in parameters by convention- al echocardiography, i. e. LVEF and LVFS among three groups. Secondly, compared with the control group, the GLS of group A and group C were significantly reduced （P 〈 0.01 ）. The GCS and GCSR of each group were significantly lower than that in the control group （ P 〈 0. 01 ）. The GCSR of three groups decreased significantly, but the difference among three groups was significant （P 〈 0.01 ）. Thirdly, The indexes of GLS, GLSR, GCS and GCSR were significantly reduced in coronary artery lesions subgroup than that of coro- nary artery without injury subgroup. Lastly, the results of DTI image showed that lateral wall myocardial early diastolic velocity of group B was higher than A and C （P 〈 0. 05 ） among the research groups. Septum myocardial systolic velocity of group A and C were significantly lower than the control group （ P 〈 0. 05 ）. Condusion Firstly, myocardial damage happened in varying degrees at different phases of KD. Meanwhile, coronary artery lesions of KD may do harm to myocardial function. Last but not least, two-dimensional speckle tracking echocardiography is an effective way to evaluate the subclinical cardiac dysfunction of KD.