超声心动图与心导管检查测量动脉导管未闭最窄内径的对比研究

Comparison between transthoracic echocardiography and cardiac catheterization in measuring diameter of patent ductus arteriosus

目的评估经胸超声心动图(TTE)测量动脉导管未闭(PDA)最窄内径的可靠性及其在PDA介入封堵治疗中的应用价值。方法收集1998年1月至2017年9月于山东大学附属省立医院住院的PDA患者846例,根据PDA最窄内径大小分为小型组(最窄内径<2.5 mm)385例、典型组(最窄内径2.5~8 mm)445例和巨大组(最窄内径≥8 mm)16例;根据年龄分为婴儿组(<1岁)161例、幼儿组(1~3岁)256例、学龄前组(3~7岁)225例、学龄期组(7~12岁)69例、青春期组(12~18岁)32例和成人组(≥18岁)103例。术前分别采用TTE和心导管检查测量PDA的最窄内径,并进行统计学分析。结果 TTE测量的患者PDA最窄内径显著大于心导管检查测量值[(3.60±1.84)mm比(3.05±1.82)mm,P<0.001],差异均有统计学意义。小型组[(2.50±0.82)mm比(1.71+0.47)mm,P<0.001]、典型组[(4.32±1.62)mm比(3.94±1.24)mm,P<0.001]TTE测量的PDA最窄内径显著大于心导管检查测量值,差异均有统计学意义。婴儿组[(3.66±1.51)mm比(3.22±1.50)mm,P<0.001]、幼儿组[(3.34±1.15)mm比(2.77±1.44)mm,P<0.001]、学龄前组[(3.33±1.84)mm比(2.71±1.71)mm,P<0.001]、学龄期组[(3.04±1.33)mm比(2.50±1.39)mm,P<0.001]、青春期组[(4.24±2.48)mm比(3.54±2.36)mm,P=0.023]、成人组[(4.89±2.49)mm比(4.40±2.58)mm,P=0.011]TTE测量的PDA最窄内径均显著大于心导管检查测量值,差异均有统计学意义。TTE测量值与心导管检查测量值的回归方程为:Y=0.315+0.762X(t=35.01,P<0.01,式中X为TTE所测内径,Y为心导管所测内径)。Bland-Altman分析显示4.5%(38/846)的点在95%一致性界限以外,在95%一致性界限以内,TTE与心导管检查测量PDA最窄内径相比,差值的绝对值最大为2.6 mm。结论 TTE与心导管检查在测量PDA最窄内径方面相关性良好,TTE对术前PDA的筛查及介入封堵术时封堵器的选择有参考价值,但二者又有差异,TTE测量值大于心导管检查测量值,因此TTE不能完全取代心导管检查。

Objective To investigate the consistency and difference between transthoracic echocardiography（TTE） and cardiac catheterization in measuring diameter of patent ductus arteriosus（PDA）,and to evaluate the reliability and value of TTE in measuring the ductus diameter. Methods A total of 846 cases under transcatheter intervention of PDA were collected from Jan. 1998 to Sep.2017. They were divided into the small PDA group（the narrowest diameter 〈2.5 mm,n=385）, the typical PDA group（the narrowest diameter 2.5-8 mm,n=445） and the large PDA group（the narrowest diameter ≥ 8 mm,n=16） depending on the ductus diameter, and also divided into 6 subgroups according to age. All the cases were examined by TTE and cardiac catheterization before intevention to obtain the narrowest ductus diameter. Results 1. The mean diameter by TTE was（3.60 ± 1.84）mm versus（3.05 ± 1.82）mm by cardiac catheterization（t=12.65,P〈0.01）. Subgroup study showed similar difference in the small PDA group and the typil PDA group. No difference found between the 2 types of measurements in large PDAs. 2.The diameters of PDA measured by TTE and cardiac catheterization showed good correlation（r=0.77,P〈0.01）3. The regression equation was Y=0.315＋0.762 X（t=35.01,P〈0.01, the X represents the diameter by TTE, the Y represents the diameter by cardiac catheterization）. 4. Bland-Altman analysis showed that 4.5%（38/846） points were outside the 95% consistency limit. Within the 95% consistency limit, the maximal absolute value of the difference was 2.6 mm. Conclusion TTE and cardiac catheterization had good correlation in measuring the diameter of PDA. TTE plays an important role in evaluating the diameter and selection for appropriate occluder. The difference in measurement by the 2 methods suggested that TTE cannot totally replace the role of cardiac catheter study.