腹主动脉“小慢波”用于评价儿童主动脉弓缩窄

Abdominal aorta “tardus parvus pattern” for evaluation oncoarctation of aortic arch in children

目的探讨主动脉弓缩窄(COA)产生小慢波的相关因素及腹主动脉小慢波对于评价儿童COA的价值。方法纳入71例超声心动图提示后经CT血管成像证实的COA患儿,将超声心动图发现小慢波者归入阳性组(n=30),其余归入阴性组(n=41);根据动脉导管闭合情况分为动脉导管闭合组(阳性亚组20例,阴性亚组18例)及动脉导管未闭(PDA)组(阳性亚组10例,阴性亚组23例);纳入同期41名健康儿童作为对照组。对比组间血流动力学参数差异,分析各参数与小慢波的相关性;以二元Logistic回归分析各参数对小慢波频谱的影响;绘制受试者工作特征(ROC)曲线计算曲线下面积(AUC),比较主动脉弓缩窄率、缩窄长度、缩窄处主动脉弓血流速度、腹主动脉血流速度等参数判断小慢波的效能。结果阴性组缩窄处主动脉弓血流速度高于对照组(P<0.05),腹主动脉血流速度低于对照组(P<0.05)。动脉导管闭合组中,阳性亚组缩窄率及缩窄长度均大于阴性亚组(P均<0.05),腹主动脉血流速度低于阴性亚组(P<0.05);小慢波形成与缩窄率、缩窄长度均呈正相关(r=0.59,0.71,P均<0.01);以缩窄率及缩窄长度判断小慢波的AUC分别为0.839和0.907。PDA组2亚组缩窄长度、动脉导管内径差异均有统计学意义(P均<0.05);小慢波形成与动脉导管内径呈负相关(r=-0.62,P<0.01),与缩窄长度呈正相关(r=0.52,P<0.01);以动脉导管内径判断小慢波的AUC为0.889。结论腹主动脉出现小慢波与主动脉弓缩窄率、缩窄长度及动脉导管内径密切相关;观察腹主动脉血流频谱可以间接推断COA,具有良好的筛选及预测价值。

Objective To explore the factors correlated with abdominal aorta tardus parvus pattern spectrum in children with coarctation of aortic arch(COA),and to observe tardus parvus pattern in abdominal aorta for evaluating COA in children.Methods Totally 71 children with echocardiographic suggested and then CT angiography confirmed COA were enrolled.According to the presence or absence of tardus parvus pattern showed with echocardiography,the children were divided into positive group(n=30)and negative group(n=41),also ductus arteriosus closure group(20 tardus parvus pattern positive and 18 negative)and patent ductus arteriosus(PDA)group(10 tardus parvus pattern positive and 23 negative).A total of 41 healthy children were included as control group during the same period.Hemodynamic parameters were compared,and the correlations of the parameters and abdominal aorta tardus parvus pattern spectrum were analyzed.The impact of constriction rate and constriction length of aortic arch,blood flow velocity of aortic arch at the constriction and of abdominal aorta on tardus parvus pattern spectrum were analyzed with binary Logistic regression.Then receiver operating characteristic(ROC)curves were drawn to calculate area under the curve(AUC)and compare the effectiveness of parameters for judging tardus parvus pattern.Results The blood flow velocity of aortic arch at the constriction was higher,of abdominal aorta was lower in negative group than those in control group(all P<0.05).In ductus arteriosus closure group,the constriction rate and constriction length of positive subgroup were greater than those of negative subgroup,but blood flow velocity of abdominal aorta was lower than that of negative subgroup(all P<0.05).There were positive correlations of the formation of abdominal aorta tardus parvus pattern spectrum and constriction rate and constriction length of aortic arch(r=0.59,0.71,both P<0.01).The AUC of constriction rate and constriction length for judging tardus parvus pattern was 0.839 and 0.907,respectively.In PDA group,statistical differences of constriction length and inner diameter of ductus arteriosus were found between subgroups(both P<0.05).The formation of tardus parvus pattern was negatively correlated with the inner diameter of ductus arteriosus(r=-0.62,P<0.01)and positively correlated with the constriction length(r=0.52,P<0.01).The AUC of the inner diameter of ductus arteriosus for judging tardus parvus pattern was 0.889.Conclusion The occurrence of abdominal aorta tardus parvus pattern spectrum closely related to constriction rate and constriction length of aortic arch,as well as the inner diameter of ductus arteriosus.Observation of blood flow spectrum of the abdominal aorta could indirectly infer COA,having good screening and prediction value.