左室心肌整体纵向应变与CRP及ESR评估川崎病急性期患儿心肌损伤的研究

Evaluation of myocardial damage by ventricular global longitudinal strain, ESR, and CRP in the acute stage of Kawasaki disease in children

目的探讨应用二维斑点追踪超声心动图技术(STE)获取左室心肌整体纵向应变(GLS)对儿童川崎病(KD)急性期心肌损伤判断的价值,及其与C反应蛋白(CRP)及红细胞沉降率(ESR)的关系。方法回顾分析2010年1月至2017年1月68例住院KD急性期患儿的临床资料,根据有无冠状动脉损伤分为无冠脉损伤组53例和冠脉损伤组15例。采用Simpon法测量左室射血分数(LVEF),应用QLA10.0软件对所采集的心肌图像进行斑点追踪并获得GLS以分析心肌运动,并收集KD患儿急性期的CRP、ESR检测结果,与56例健康体检儿童作比较;分析KD患儿炎症指标与GLS的相关性。结果 KD急性期患儿GLS、CRP、ESR均高于健康对照组,差异有统计学意义(P均<0.01);两组间LVEF的差异无统计学意义(P>0.05)。无冠脉损伤组CRP、ESR水平明显高于冠脉损伤组,差异有统计学意义(P均<0.01),两组间LVEF及GLS的差异无统计学意义(P>0.05)。KD患儿急性期GLS与急性期CRP、ESR均呈正相关(r=0.62、0.57,P均<0.05)。结论 STE获得的GLS在KD急性期显著升高,并与CRP升高有关,但与冠状动脉损伤无关。

Objective To explore the value of left ventricular myocardial global longitudinal strain(GLS)obtained by two-dimensional speckle tracking echocardiography(STE)in the assessment of acute myocardial injury in children with Kawasaki disease(KD)and its relationship with c-reactive protein(CRP)and erythrocyte sedimentation rate(ESR).Method The clinical data of 68 hospitalized children with acute KD from January 2010 to January 2017 were retrospectively analyzed.According to the presence or absence of coronary artery injury,KD children were divided into non-coronary artery injury group(53 cases)and coronary artery injury group(15 cases).The Simpon method was used to measure the left ventricular ejection fraction(LVEF),and QLA10.0 software was used to track the collected myocardial images and obtain GLS to analyze the myocardial movement.Results of CRP and ESR in acute phase of KD children were collected and compared with those of 56 healthy children.Correlation between inflammatory indexes and GLS in children with KD was analyzed.Results The levels of GLS,CRP and ESR in children with acute KD were higher than those in healthy controls,and there were significant differences(P all<0.01).There was no difference in LVEF between the two groups(P>0.05).The levels of CRP and ESR in non-coronary artery injury group were significantly higher than those in coronary artery injury group,and there were significant differences(P all<0.01).There was no difference in LVEF and GLS between the two groups(P>0.05).In acute phase of KD,GLS was positively correlated with CRP and ESR(r=0.62,0.57;P all<0.05).Conclusion The GLS obtained by STE was significantly elevated in the acute phase of KD and was associated with the increased CRP,but was not related to coronary artery injury.