组织多普勒Tei指数检测早期Duchenne型肌营养不良儿童左室功能损伤

Early Detection of Left Ventricular Dysfunction in Children with Duchenne Muscular Dystrophy by Tei Index Derived from Tissue Doppler Imaging

目的探讨应用组织多普勒成像(TDI)Tei指数评价早期Duchenne型肌营养不良(DMD)儿童左室功能损伤的价值。方法研究对象为2020年1月至2020年12月于本院进行超声心动图检查的26例DMD患儿及25例健康儿童。测量左室射血分数、二尖瓣口E峰、A峰,计算E/A等常用超声参数。应用TDI测得二尖瓣环左室侧壁处运动曲线,计算Tei指数。结果两组间的左室射血分数与二尖瓣口E、A、E/A无明显差异。DMD组Tei指数显著升高(P<0.05)。Tei指数区分DMD患儿与正常儿童的曲线下面积为0.81(95%可信区间:0.68,0.93),以Tei指数为0.35为截点预测左室功能受损的敏感度和特异度分别为84.6%和60.0%。结论组织多普勒Tei指数能早期检出DMD患儿的左心室功能损伤,对临床治疗具有重要指导意义。

Objective To explore the value of Tei index in early detecting left ventricular dysfunction by tissue Doppler imaging in children with Duchenne muscular dystrophy(DMD).Methods Twenty-six children with DMD and 25 healthy children were recruited for echocardiography.Left ventricular eject fraction(LVEF)was measured by Simpson’s biplane method.The peak of early diastolic flow velocity(E)and the peak of atrial flow velocity(A)were measured by pulse Doppler,and E/A ratio was calculated accordingly.With TDI,the time intervals of mitral annulus's motion such as isovolumic relaxation time(IRT),isovolumic contraction time(ICT)and ejection time(ET)were measured.The Tei index was calculated by IRT+ICT derived from ET.Results The DMD group and control group were comparable in terms of age,weight and body surface area(BSA).The conventional ultrasonic parameters including LVEF,E,A,and E/A ratio were not found to differ between the two groups.Tei index was significantly greater in the DMD group compared to the control group(0.40±0.06 vs.0.34±0.02,P<0.001).The area under the ROC curve of Tei index to distinguish the overall left ventricular dysfunction of children with DMD from that of control was 0.81(95%confidence interval:0.68,0.93),with Tei index cutoff value of 0.35 had a sensitivity of 84.6%and a specificity of 60.0%in differentiating DMD children from controls.Conclusion TDI-Tei index can be adopted for early detection of left ventricular dysfunction in DMD patients,which could provide valuable reference for early intervention.