EV71手足口病神经源性心脏功能不全的实时三维超声心动图检测  

Neurogenic cardiac dysfunction in children with EV-71 hand-foot-and-mouth disease by real-time three-dimensional echocardiography

作　　者：刘晓[1] 夏焙[1] 冯霞[1] 梁雪冰[1] 于红奎[1] 刘力[1] 陶宏伟[1] 

机构地区：[1]深圳市儿童医院超声影像科,518026

出　　处：《中华医学超声杂志（电子版）》2010年第11期32-36,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：广东省医学科研基金项目(A2006598)

摘　　要：目的探讨应用实时三维超声心动图检测EV71手足口病患儿神经源性心功能不全的特点及其临床意义。方法 2005年12月至2009年12月深圳市儿童医院EV71手足口病患儿44例(手足口病组),临床上分为4期:Ⅰ期手足口病、疱疹性咽颊炎,Ⅱ期神经受累,Ⅲ期自主神经功能紊乱及肺水肿,Ⅳ期生命体征稳定。采用实时三维超声心动图多平面定量检测各期患儿的收缩功能指标:左心室舒张末期容积(LVEDV)、每博输出量(SV)、心排出量(CO)、左心室射血分数(LVEF)、室壁运动积分(WMSI)等;在组织速度成像条件下取二尖瓣环6个点的同步组织速度曲线,分别测量舒张期早期及晚期峰值速度(Ve及Va),取其平均值计算Ve/Va;取同期一过性发热患儿31例为对照组,通过对两组心脏收缩参数比较,分析影响心脏功能变化的相关因素。结果与对照组比较,手足口病组Ⅰ期患儿心脏功能指标正常,无血糖、心率升高。Ⅱ期患儿存在节段性室壁运动异常,WMSI升高(1.04±0.09,1.00±0.00,P<0.05),血糖明显升高[(6.5±1.2)mmol/L,(4.3±0.7)mmol/L,P<0.01)],但心率差异无统计学意义(P>0.05)。Ⅲ期患儿表现为显著的心脏功能不全,以SV降低最为明显[(7.3±2.8)ml,(13.7±7.8)ml,P<0.01],Ⅲ期患儿心率、血糖、WMSI[(156.0±26.2)次/min、(7.3±2.3)mmol/L、1.44±0.45]与对照组相应指标[(108.1±10.7)次/min、(4.3±0.7)mmol/L、1.00±0.00]比较均显著升高(P均<0.01)。Ⅱ期和Ⅲ期患儿高血糖比例分别为33.3%、54.5%,与对照组患儿高血糖比例(0%)比较显著升高(P<0.01)。Ⅳ期患儿与对照组比较,心率、血糖正常,SV仍较低[(9.9±4.2)ml,(13.7±7.8)ml,P<0.05],WMSI(1.05±0.07,1.00±0.00)仍较高,与对照组WMSI比较差异仍有统计学意义(P<0.01),其余心脏功能指标与对照组比较均无明显差异。1例Ⅲ期患儿死于心力衰竭和肺水肿。结论重症EV71手足口病患儿存在神经性应激性心脏功能不全,主要表现为以心尖为�Objective To evaluate the neurogenic cardiac dysfunction and its clinical significance in children with enterovirus-71 hand-foot-and-mouth disease（EV-71 HFMD） by real-time three-dimensional echocardiography.Methods A retrospective study was conducted in 44 patients with HFMD admitted to Shenzhen Children＇s Hospital from December 2005 to December 2009.The subjects were divided into four groups based on their clinical features：stageⅠ：hand-foot-and-mouth disease,herpetic angina stage,stageⅡ：nerve involved stage,stage Ⅲ：autonomic nerve disorder and pulmonary edema stage,stage Ⅳ：vital signs stable stage.Real-time three-dimensional echocardiography showed multiplanar quantitative detection for contractile function of various indicators in children of left ventricular end-diastolic volume（LVEDV）,stroke volume（SV）,cardiac output（CO）,left ventricular ejection fraction（LVEF）,wall motion score index（WMSI）,etc.Six points of mitral annulus tissue velocity curves were obtained by tissue velocity imaging simultaneously,early and late diastolic peak velocity（Ve and Va） were measured based on the mean Ve/Va.Thirty-one children over the same period with a transient fever were taken as control group and the factors related to heart function were analysed.Results The indicators of cardiac function in children of stage Ⅰ were healthy without increases in the glucose level and heart rate.In patients of stageⅡ,segmental wall motion abnormalities existed：WMSI was higher（1.04±0.09 vs 1.00±0.00,P0.05） and glucose level increased significantly with a ratio of 33.3% of hyperglycemia[（6.5±1.2）mmol/L vs（4.3±0.7）mmol/L,P 0.01）].The patients of stage Ⅲ showed significant heart dysfunction,SV decreased significantly with lower CO、LVEF、Ve/Va[（7.3±2.8）ml vs（13.7±7.8）ml,P0.01;（1.00±0.50）L/min vs（1.59±0.80）L/min;（45.4±21.3）% vs（63.0±4.8）%;1.4±0.6 vs 2.1±0.9,P0.05],and WMSI increased significantly（1.44±0.45 vs 1.00±0.00,P0.01）,accompani

关 键 词：超声心动图描记术 三维成像 手足口病 心脏功能不全 

分 类 号：R445.1[医药卫生—影像医学与核医学] R725.1[医药卫生—诊断学]