二维斑点追踪技术预测静脉注射免疫球蛋白抵抗急性期川崎病患者心肌损伤

Two-dimensional speckle tracking imaging in predicting myocardial injury of Kawasaki disease patients with intravenous immunoglobulin resistant during acute phase

目的采用二维斑点追踪技术(2DSTI)观察静脉注射免疫球蛋白(IVIG)抵抗急性期川崎病(KD)患者左心室心肌收缩功能损伤特点。方法收集IVIG应答患者40例(IVIG应答组),以诊断为急性期KD的住院患者中年龄、性别相匹配的IVIG抵抗患者40例为IVIG抵抗组,将后者进一步分为冠状动脉扩张(CAD)亚组和冠状动脉正常(NCAD)亚组,获取常规超声心动图参数、2DSTI参数及实验室指标。比较IVIG抵抗组与IVIG应答组间常规超声心动图参数、2D STI参数和实验室指标,以及CAD亚组与NCAD亚组各参数间差异,并通过ROC曲线获取IVIG抵抗患者2DSTI参数预测值。结果与IVIG应答组相比,IVIG抵抗组CAD发生率、左心室质量及左心室质量指数均升高,收缩期左心室整体峰值纵向应变(GLS)及整体峰值环向应变(GCS)均减小,血清白蛋白、红细胞血沉速度、C反应蛋白及血小板均升高(P均<0.05)。以GLS绝对值16.8%为阈值,曲线下面积0.769(P=0.021),预测IVIG抵抗的敏感度为79.27%,特异度为68.36%;以GCS绝对值15.9%为阈值,曲线下面积0.749(P=0.038),预测IVIG抵抗的敏感度为71.43%,特异度为57.28%。结论 IVIG抵抗KD患者心肌损伤较IVIG应答KD患者更严重,可能是心肌炎性损伤而非冠状动脉损伤的结果。2DSTI技术可预测急性期IVIG抵抗患者心肌损伤。

Objective To analyze the characteristics of left ventricular systolic function in Kawasaki disease （KD） patients with intravenous immunoglobulin （IVIG） resistant during acute phase by two-dimensional speckle tracking imaging （2D STI）. Methods IVIG resistant patients （n=40） as well as age and gender matched IVIG responder patients （n=40） were selected from KD patients in acute phase. Patients in IVIG resistant group were further divided into coronary artery dilation （CAD） subgroup and no coronary artery dilation （NCAD） subgroup. Then conventional echocardiography, 2D STI and laboratory indexes were acquired and compared between IVIG resistant group and IVIG responder group, as well as between CAD and NCAD subgroup. ROC curve analysis was used to determine threshold values of 2D STI measurements associated with IVIG resistance. Results Compared with IVIG responder group, coronary artery dilation, left ventricular mass and left ventricular mass index increased, systolic global longitudinal strain （GLS） and systolic global circumferential strain （GCS） decreased, albumin, erythrocyte sedimentation rate, C-reactive protein and platelet increased in IVIG resistant group （all P〈0.05）. Taking absolute GLS 16.8% as a threshold, the area under curve （AUC） was 0.769 （P=0.021）, sensitivity, specificity in diagnosis of IVIG resistant was 79.27%, 68.36%. Taking absolute GCS 15.9% as a threshold, AUC was 0.749 （P=0.038）, sensitivity, specificity in diagnosis of IVIG resistant was 71.43%, 57.28%. Conclusion IVIG resistant KD patients present significantly greater systolic dysfunction compared with responders in patients with KD, which may be the results of myocardium infection other than coronary artery lesions. 2D STI may predict myocardial injury in IVIG resistant KD patients.