青少年特发性脊柱侧凸患者胸弯对心脏结构和功能的影响

Effection of thoracic curve on cardiac structure and function in patients with adolescent idiopathic scoliosis

目的：研究青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者心脏结构和功能特点，探讨脊柱侧凸胸弯对心脏结构和功能的影响。方法：收集2008年6月~2011年6月南京大学医学院附属鼓楼医院脊柱外科收治的主弯为胸弯的女性AIS患者资料，排除合并有先天性心脏病的15例患者，共374例纳入研究，年龄10～18岁（14.9±1.8岁）。回顾性分析心脏超声多普勒资料，得到AIS患者的心脏结构及功能指标，包括舒张末期室间隔厚度（interventricular septum thickness in end diastole，IVSTD）、舒张末期左室内径（left ventricular inner diameter in end diastole，LVDD）、收缩末期左室内径（left ventricular inner diameter in end systole，LVIDS）、舒张末期左室后壁厚度（posterior wall of left ventricle in end diastole，LVPWD）、主动脉根径（diameter of aortic root，DAR）、舒张末期左房内径（left atrial dimension，LAD）、射血分数（ejection fraction，EF）、肺动脉直径（diameter of arteria pulmonalis，DAP）、左室舒张早期血流充盈峰值流速（E峰），舒张晚期充盈峰值流速（A峰）、主动脉流速（aortic flow velocity，AV）。根据脊柱侧凸冠状面角不同，分为小Cobb角组（Cobb角≤70°）和大Cobb角组（Cobb角〉70°），比较两组心脏结构和功能指标；依据矢状面角不同，分为后凸减小（Cobb角〈10°）、正常后凸（Cobb角10°~40°）及后凸增加（Cobb角〉40°）3组，比较心脏结构和功能指标，确立对心脏结构和功能产生影响的相关单因素。再通过多重线性回归分析，研究对心脏结构和功能产生影响的独立因素及影响强度大小。结果：所有患者心脏结构和功能指标（LVDD、LVIDS、IVSTD、DAR、LVPWD、LAD、DAP、EF、E、A、E/A及AV）数值均在正常范围。在胸椎冠状面角度≤70°组与〉70°组之间的LVDD、LVIDS、AV有显著性差异（P〈0.05），IVSTD、DAR、LVPWD、LAD、DAP、EF、E、A、E/A两组之间无统计学差异（P〉0.05）。在矢状面角度〈10°组与10°～40°组之间的LVDD有显著性差异（P〈0.05），在矢状面角度〈10°组与〉40°组之间的IVSTD、LAD、DAP有显著性差异（P〈0.05），在矢状面角度10°～40°组与〉40°组之间的EF有显著性差异（P〈0.05），3组间LVIDS、DAR、LVPWD、E、A、E/A及AV无统计学差异（P〉0.05）。多重线性回归分析显示，冠状面角度是LVDD、LVIDS的独立影响因素（P〈0.05），其标准化偏回归系数分别为-0.150、-0.162；年龄是LVDD、LVIDS的独立影响因素（P〈0.05），其标准化偏回归系数分别为0.139、0.146；其标准化偏回归系数绝对值冠面角度大于年龄；年龄亦是IVSTD、DAR的独立影响因素（P〈0.05）, 其标准化偏回归系数分别为0.217、0.272。结论：AIS患者的心脏结构和功能指标基本上处于正常范围, 但胸弯的冠矢状面畸形仍对AIS患者心脏结构产生影响，冠状面角度越大，左室内径值越小。

Objectives： To investigate the features of cardiac structure and function in adolescent idiopathic scoliosis（AIS） patients, and to further discuss the influence of cardiac structure and function on related factors with scoliosis of main thoracic. Methods： From June 2008 to June 2011, the clinical data of 374 AIS patients receiving spinal correction in the department of spine surgery of Drum Tower Hospital affiliated to Nanjing University were reviewed in this study. All patients underwent a full clinical examination. 374 of AIS patients without congenital heart disease（15） were selected, who were all females and subjected to main thoracic. The mean age of these patients was 14.9±1.8 years, ranging from 10 to 18 years. All patients underwent echocardiography for routine screen of cardiac abnormities, and echocardiographic records of 374 patients were available. All these clinical data and imaging records were reviewed. The cardiac structure and function included interventricular septum thickness in end diastole（IVSTD）, left ventricular inner diameter in end dias？鄄tole（LVDD）, left ventricular inner diameter in end systole（LVIDS）, posterior wall of left ventricle in end diastole（LVPWD）, diameter of aortic root（DAR）, left atrial dimension（LAD）, ejection fraction（EF）, diameter of arteria pulmonalis（DAP）, left ventricular peak systolic blood flow velocity in early diastole（E）, left ventricular peak systolic blood flow velocity in end diastole（A） and aortic flow velocity（AV）. The patients were classified according to the coronal angle and thoracic kyphosis to compare the indexes related to cardiac structure and function. Through the multiple linear regression analysis to the independent influence of cardiac structure and function. Results： Cardiac structure and function indexes（LVDD, LVIDS, IVSTD, DAR, LVPWD, LAD, DAP, EF, E, A, E/A and AV） were all in the normal level. The patients were classified into 2 groups, which were Cobb′s angle ≤70° and 〉70° according to the Cobb′s angle in coronal plane. There were significant differences in the LVDD, LVIDS, AV between 2 groups（P〈0.05）; no significant differences in the IVSTD, DAR, LVPWD, LAD, EF, E, A and E/A were noted between 2 groups（P〉0.05）. When classifying the patients into 3 groups, which were Cobb′s angle 〈10°, 10°-40° and 〉40° according to the Cobb′s angle in sagittal plane, there was significant difference in the LVDD between the group of 〈10° and the group of 10°-40°（P〈0.05）; significant differences in the IVSTD, LAD and DAP between the group of 〈10° and the group of 〉40°（P〈0.05） were noted; there was significant difference in the EF between the group of 10°-40° and the group of 〉40°（P〈0.05）; there were no significant differences in the LVIDS, DAR, LVPWD, E, A, E/A and AV in 3 groups（P〉0.05）. It was found that age and coronal angle were the independent influence factors of LVDD and LVIDS（P〈0.05）. The standard partial regression coefficient of coronal angle were -0.150 and -0.162; The standard partial regression coefficients of age were 0.139 and 0.146. Standardized partial regression coefficient absolute value of the Cobb′s angle in coronal plane was greater than the age. It was found that age was also the independent influence factor of IVSTD and DAR（P〈0.05）. The standard partial regression coefficients of age were 0.271 and 0.272. Conclusions： Cardiac structure and function indexes are overall basically in the normal range in AIS patients. However, coronal deformity and thoracic kyphosis will influence the cardiac structure. The inner diameter of left ventricle decreases with the increasing angle of coronal plane.