有创性心导管检查对限制性心肌病和缩窄性心包炎的诊断价值

Diagnostic value of invasive cardiac catheterization for constrictive pericarditis and restrictive cardiomyopathy

目的探讨有创性心导管检查对限制性心肌病和缩窄性心包炎的诊断价值。方法收集2002年2月至2015年12月上海交通大学医学院附属上海儿童医学中心收治的27例缩窄性心包炎或限制性心肌病患儿，包括10例最终经手术明确诊断为缩窄性心包炎和17例限制性心肌病进行了心导管检查，记录心导管检查中所有的压力曲线，分析2组疾病压力指标的异同。记录9例局部麻醉患者深呼吸下心腔压力变化曲线。结果限制性心肌病组和缩窄性心包炎组患儿肺动脉收缩压分别为（50.2±12.0） mmHg（1 mmHg＝0.133 kPa）及（38.1±6.8） mmHg，左-右心室舒张末压差分别为（7.8±5.5） mmHg及（1.8±4.7） mmHg，右心室舒张末压与收缩压的比值分别为0.27±0.10及0.45±0.20，2组比较差异均有统计学意义（t＝2.912、2.787、2.418，均P〈0.05）；但2组疾病在上述3项指标均存在结果交叉重叠，且任一指标的诊断敏感性〈66.7%。缩窄性心包炎组患儿在不同的呼吸周期左、右心室充盈曲线呈矛盾运动，而限制性心肌病组患儿表现为左、右心室变化一致。限制性心肌病组右心室/左心室收缩面积指数（SAI）为0.70±0.14，缩窄性心包炎组SAI为1.20±0.03，2组比较差异有统计学意义（t＝6.152，P〈0.01），诊断敏感性和特异性均为100%。结论心导管检查对于鉴别限制性心肌病及缩窄性心包炎有重要意义，尤其是不同呼吸相右心室/左心室SAI是可靠指标。

Objective To evaluate the diagnostic value of invasive cardiac catheterization for restrictive cardiomyopathy （RCM） and constrictive pericarditis （CP）. Methods Twenty - seven children with CP or RCM hospitalized in Department of Cardiology, Shanghai Children＇s Medical Center, School of Medicine, Shanghai Jiaotong University from February 2002 to December 2015 ,were selected,including 10 patients who had been surgically documented CP and 17 patients with RCM who underwent cardiac catheterization. Intracardiac pressure waveforms were recorded and all the t indexes of pressure of all the patients were analyzed. The changes of cardiac pressure under deep breathing in 9 patients with local anesthesia was recorded. Results There were significant differences in pulmonary artery pressure,difference between left ventricular enddiastolic pressure （LVEDP） and right ventricular end -diastolic pressure （ RVEDP）, and the ratio of RVEDP/right ventricular systolic pressure between group RCM and group CP [ （ 50.2± 12.0） mmHg（ 1 mmHg =0. 133 kPa） vs. （38.1 ±6.8） mmHg, （7.8 ±5.5） mmHg vs. （1.8 ±4.7）mmHg,0. 27 ±0. 10 vs. 0.45 ±0.20, respectively ; t = 2.912,2. 787,2.418, all P 〈 0.05 ]. However, there was overlapping for these criteria, and the predictive sensitivity of any of the criteria was less than 66.7%. In patients with CP,reciprocal changes in the filling between right ventricle and left ventricle occurred during respiration. In patients with RCM, the right ventricle and left ventricle pressures moved concordantly with respiration. The systolic area index was greater in group CP than that in group RCM （ 1.20 ± 0.03 vs. 0. 70 ±0.14 ） , and the difference was significant （ t = 6. 152,P 〈 0.01 ）. The systolic area index had a sensitivity of 100.0% and a predictive accuracy of 100.0% for the identification of patients with surgically proven CP. Conclusions Measurements in catheterization, especially the ratio of right ventricular to left ventrieular systolic area during inspiration and expiration is a reliable catheterization criterion for differentiating CP from RCM.