左心室纵向应变评估川崎病急性期患儿心肌损伤的相关研究  

Evaluation of left ventricular myocardial deformation in children at acute stage of Kawasaki disease with ventricular longitudinal strain

作　　者：徐敏[1] 周益平[2] 龚明霞[1] 刘飞[1] 孟军[1] 杨玲[3] 

机构地区：[1]苏州大学附属第三医院常州市第一人民医院心功能科,江苏常州213003 [2]苏州大学附属第三医院常州市第一人民医院儿科,江苏常州213003 [3]苏州大学附属第三医院常州市第一人民医院心内科,江苏常州213003

出　　处：《现代预防医学》2017年第18期3445-3449,共5页Modern Preventive Medicine

基　　金：常州市科技局应用基础研究CJ20160030;常州市卫计委重大课题ZD201407

摘　　要：目的通过二维斑点追踪技术获取左室心肌纵向应变,探讨其对儿童川崎病急性期心肌损伤的诊断及预测价值。方法 60例KD急性期患者根据有无冠状动脉扩张(CAE)分为无冠脉损伤组(B组)和冠脉损伤组(C组);选择56例健康体检儿童作为对照组(A组),采集研究对象心肌动态图像,行二维超声心动图检查,记录心尖位左四腔观、二腔观及长轴观图像,使用Simpon法进行左室射血分数(LVEF)测量。应用QLA10.0软件对所采集的心肌图像进行斑点追踪并获得左室二腔心(AP2LS)、三腔心(AP3LS)、四腔心(AP4LS)纵向应变值及左室整体纵向应变值(GLS),分析心肌运动情况。分别计算AP2LS、AP3LS、AP4LS及GLS判断CAE的ROC曲线下面积(AUC),获得鉴别CAE的最佳临界值。结果 (1)常规超声指标LVEF差异无统计学意义。(2)3组间及组间AP2LS、AP3LS、AP4LS及GLS比较差异均有统计学意义(P<0.01)(3)AP2LS、AP3LS、AP4LS、GLS诊断CAE的AUC分别为0.68(95%CI:0.53~0.83),0.86(95%CI:0.74~0.98),0.82(95%CI:0.71~0.93),0.94(95%CI:0.88~1.00)。以AP2LS诊断CAE的AUC为对照,AP3LS、GLS与其比较差异有统计学意义(P<0.05)。ROC曲线显示GLS诊断CAE的敏感度为94%、特异度为90%,AP3LS诊断CAE的敏感度及特异度分别为74%和90%。结论二维斑点追踪成像左室心肌纵向应变技术可早期评估川崎病患儿心肌的受损情况。Objective The aim of this study was to evaluate the value of left ventricular myocardial deformation in children at the acute stage of Kawasaki disease（KD） with longitudinal strain derived from two-dimensional global strain-speckle tracking imaging（2D-STI）. Methods A total of 60 patients with KD were recruited as the research groups. According to the coronary arterial ectasis（CAE）, they were divided into no CAE group（group B） and CAE group（group C）. Meanwhile, 56 healthy subjects were recruited as a control group（group A）. All subjects were collected with cardiac motion images. High frame rate two-dimensional images were obtained from the left ventricle in the three groups. Left ventricular ejection fraction was measured using a modified Simpson＇s biplane method. Two-chamber heart, three-chamber heart, four-chamber heart longitudinal strain values, and left ventricular global longitudinal strain were obtained by QLA10.0 software offline. The area under（AUC） of the receiver operating characteristic curve（ROC） of CAE was calculated. Results（1） There was no significant difference in LVEF among three groups（P〉0.05）.（2） Differences of GLS, AP2 LS, AP3 LS and AP4 LS among groups were all statistically significant（P〈0.01）.（3） AUC of AP2 LS, AP3 LS, AP4 LS, GLS for detecting CAE were 0.68, 95% CI： 0.53 ~ 0.83;0.86, 95% CI： 0.74 ~ 0.98; 0.82, 95% CI： 0.71 ~ 0.93; 0.94, 95% CI： 0.88 ~ 1.00. AUC of GLS and AP3 LS were higher than the AP3LS（P〈0.01, P〈0.05）. Sensitivity and specificity of GLS in diagnosis of CAE were 94.0% and 90.0%, respectively.The sensitivity and specificity of AP3 LS in diagnosis of CAE were 74.0% and 90.0%, respectively. Conclusion Two-dimensional speckle tracking imaging of left ventricular myocardial longitudinal strain would be a useful tool for early evaluating left ventricular myocardial deformation in children at acute stage of Kawasaki disease（KD）.

关 键 词：皮肤黏膜淋巴结综合征 超声心动描记术 应变 早期诊断 

分 类 号：R541[医药卫生—心血管疾病]