肥胖儿童心脏结构和功能特征

The Characteristics of the Cardiac Structure and Function of Obese Children

目的:评价肥胖儿童心脏结构和功能的特点,旨在评估心脏早期改变的风险性和不良后果。方法:将北京市5所小学的1034名8~9岁儿童(男n=514,女n=520)依照体脂率(BF%)分类标准,男、女各分成体脂率正常组(男n=206,女n=336)、超重组(男n=94,女n=80)、肥胖组(男n=214,女n=104)。对所有受试者进行超声心动图检查,并分性别比较各组心脏结构和功能指标。结果:(1)与体重正常儿童相比,肥胖儿童左心室舒张末期内径(LVIDd)、舒张末期左室后壁厚度(LVPWd)、左心室舒张末期容积(EDV)、左心室质量(LVM)、左心室质量指数(LVMI)、每搏量(SV)、心输出量(CO)均非常显著性增加(P<0.01),但射血分数(EF)、短轴缩短率(FS)无统计学差异(P>0.05)。(2)儿童BF%与主动脉根部内径(AOD)、舒张末期室间隔厚度(IVSd)、LVIDd、舒张末期左室后壁厚度(LVPWd)、EDV、LVM、LVMI、CO、SV呈正相关(P<0.01)。(3)8~9岁超重肥胖儿童心脏向心性肥厚的比例为6.1%。与左室正常构型儿童相比,心脏向心性肥厚儿童形态指标BF、BF%、BMI和心脏指标LVM、LVMI、相对室壁厚度(RWT)非常显著性增加(P<0.01),CO显著性增加(P<0.05),SV显著性减小(P<0.05)。结论:以体脂率作为肥胖筛查指标发现,8~9岁肥胖儿童发生心脏重构和功能改变,包括左心室扩大、室壁增厚、左室质量增加、左室肥厚及每搏量、心输出量增加,且随肥胖程度加重,向心性肥厚发生率增高。

Objective To observe the cardiac structure and function of obese children, so as to evaluate the risk of early pathological changes and severe consequences. Methods One thousand and thirty- four children （aged between 8 and 9,of 520 females） from 5 primary schools in Beijing were recruited and randomly divided into 2 normal groups （206 males and 336 females）,2 overweight groups （94 males and 80 females） and 2 obesity groups （214 males and 104 females） according to the sex and body fat percentage （BF%. The cardiac structure and function were measured using echocardiography. Results （1） Compared with the normal groups, significant increase was observed in the left ventricular internal diameter at end-diastole （LVIDd）,left ventricular posterior wall dimensions （LVPWd）,left ventricular end-diastolic volume （EDV）,left ventricular mass （LVM）,left ventricular mass index （LYMI）, stroke volume （SV） and cardiac output （CO） in the obesity groups （P〈0.01）. However, no significant differences were observed between the 2 groups in the ejection fraction （EF） and fractional shortening （FS） （P〉0.05）. （2） BF% was positively correlated with the aortic root dimension,IVSd,LVIDd,LVP- Wd,EDV,LVM,LVMI,CO and SV （P〈0.01）. （3） The prevalence of concentric hypertrophy was 6.1% among the overweight and obese children aged between 8 and 9. Compared with the normal children, significant increase was found in their BF,BF%,body mass index,LVM,LVMI and RWT,but significant decrease in SV （P〈0.05）. Conclusions Screening with BF% ,the overweight and obese children between 8 and 9 years old have showed obvious changes in their cardiac structure and function, including higher left ventricular internal diameter at end-diastole,thicker left ventricular wall as well as bigger left ventrieular end-diastolic volume,left ventricular mass,left ventricular mass index,stroke volume and cardiac output. Meanwhile, the prevalence of concentric hypertrophy increased with the increase of body fat percentage.