应变定量分析技术评估川崎病患儿左心房功能

Strain quantitative analysis technique for evaluation of left atrial function in children with Kawasaki disease

目的观察应变定量分析技术评估川崎病(KD)患儿左心房功能的价值。方法前瞻性纳入43例拟接受静脉注射免疫球蛋白(IVIG)治疗的KD患儿(KD组),包括23例冠状动脉扩张(扩张亚组)及20例无扩张(无扩张亚组);以50名健康儿童为对照组。分别于KD急性期(IVIG前10~12 h)、亚急性期(治疗后1周)及恢复期(治疗后6~10周)行超声心动图检查,测量左心房收缩期存储应变(LASr)、舒张早期管道应变(LAScd)、舒张晚期收缩应变(LASct),以及左心室整体纵向应变(LVGLS)、基底段、中间段、心尖段纵向应变(LS);比较组间及KD亚组间不同时期左心房应变参数,以Pearson相关分析评价急性期KD患儿左心房与左心室应变参数的相关性。结果KD组急性期、亚急性期LASr、LAScd、LASct、LVGLS及左心室各节段LS均低于对照组(P均<0.05);KD组恢复期基底段LS低于对照组(P<0.05)。KD组内,相比急性期,亚急性期LASr、LAScd、LASct、LVGLS及左心室各节段LS均明显增加(P均<0.05),恢复期LASr、LAScd、LASct、LVGLS、中间段LS及心尖段LS均较亚急性期进一步增加(P均<0.05)。急性期KD患儿LASr、LAScd与LVGLS、中间段LS、心尖段LS均呈正相关(r=0.43~0.67,P均<0.05)。亚组间急性、亚急性期左心房LS参数差异均无统计学意义(P均>0.05);扩张亚组恢复期LASr、LAScd均低于无扩张亚组(P均<0.05),亚组间LASct差异无统计学意义(P>0.05)。结论KD患儿左心房功能改变与其左心室收缩功能密切相关,且在KD恢复期受冠状动脉扩张影响。

Objective To observe the value of quantitative analysis technique for evaluating left atrial function in children with Kawasaki disease(KD).Methods Totally 43 children with KD(KD group)who would undergo intravenous immunoglobulin(IVIG)therapy were prospectively enrolled,including 23 with(ectasia subgroup)and 20 without coronary artery ectasia(non-ectasia subgroup),while 50 healthy children were enrolled as control group.Children in KD group.Echocardiography was performed in acute phase(10-12 hours before IVIG therapy),subacute phase(1 week after therapy)and convalescent phase(6-10 weeks after therapy)of KD.The left atrial reservoir strain(LASr),early diastolic conduit strain(LAScd),late diastolic contractile strain(LASct),left ventricular global longitudinal strain(LVGLS),basal segment,middle segment and apical segment longitudinal strain(LS)were measured.Strain parameters of different periods were compared between groups and subgroups in KD group,and left atrial strain parameters in KD subgroup were compared among different periods.Pearson correlation analysis was used for evaluation of the correlations of left atrium and left ventricle strain parameters in children with acute KD.Results LASr,LAScd,LASct,LVGLS and left ventricular segment LS of KD group in acute and subacute phase were all lower than those of control group(all P<0.05),while the basal segment LS of KD group in convalescent phase was lower than that of control group(P<0.05).In KD group,compared with acute stage,LASr,LAScd,LASct,LVGLS and left ventricular segment LS significantly increased in subacute phase(all P<0.05),while in convalescent phase,LASr,LAScd,LASct,LVGLS,middle segment LS and apical LS further increased(all P<0.05).LASr and LAScd in acute phase of KD group were positively correlated with LVGLS,middle segment LS and apical segment LS(r=0.43-0.67,all P<0.05).In the acute and subacute phases,no significant difference of left artial LS parameters was found between subgroups within KD group(all P>0.05).LASr and LAScd in convalescent phase of ectasia subgroup were lower than those of non-ectasia subgroup(all P<0.05),while no significant difference of LASct was found between subgroups within KD group(P>0.05).Conclusion Quantitative analysis technique could be used to evaluate left atrial function in KD children.Changes of left atrial function in KD children were closely related to left ventricular systolic function,which was affected by coronary artery ectasia in convalescent phase.