海拔高度对克山病患者右心结构及功能的影响  

Effects of altitude on the structure and function of right heart in patients with chronic Keshan disease

作　　者：种冠峰[1] 冯红旗[2] 王秀红[1] 王园园[1] 李丹丹[2] 郭敏[3] 赵生成[3] 邵建赟[4] 王明亮[1] 李为波 Chong Guanfeng;Feng Hongqi;Wang Xiuhong;Wang Yuanyuan;Li Dandan;Guo Min;Zhao Shengcheng;Shao Jianyun;Wang Mingliang;Li Weibo(Department of Keshan Disease and Arsenic Poisoning, Shandong Institute for Endemic Diseases Control and Treatment, Jinan 250014, China;Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin 150081, China;Tibet Center for Disease Control and Prevention, Lhasa 850030, China;Gansu Provincial Centre for Disease Control and Prevention, Lanzhou 730000, China)

机构地区：[1]山东省地方病防治研究所克山病与砷中毒科,济南250014 [2]哈尔滨医科大学中国疾病预防控制中心地方病控制中心克山病防治研究所,150081 [3]西藏自治区疾病预防控制中心,拉萨850030 [4]甘肃省疾病预防控制中心,兰州730000

出　　处：《中华地方病学杂志》2019年第10期782-786,共5页Chinese Journal of Endemiology

基　　金：山东省医药卫生科技发展计划项目(2016WS0373).

摘　　要：目的分析不同海拔高度慢型克山病(CKD)患者超声心动图的差异性表现,探讨不同海拔高度对CKD患者右心结构及功能的影响,为CKD的影像学诊断提供参考依据。方法根据我国地势的三级阶梯分布,在第一级阶梯(4000m以上)的西藏自治区选择30例CKD患者作为青藏高原组,在第二级阶梯(1000~2000m)的甘肃省选择31例CKD患者作为黄土高原组,在第三级阶梯(500m以下)的山东省选择42例CKD患者作为平原组。对所有研究对象进行超声心动图检查,就心脏形态、血流动力学和心功能3个方面进行对比分析。结果青藏高原组、黄土高原组和平原组的右房橫径[RATD,(49.75±8.40)、(45.64±7.63)、(43.56±7.34)mm]、右室橫径[RVTD,(50.89±7.13)、(46.56±5.62)、(43.27±6.01)mm]、右室壁厚度[RVWT,(4.75±1.02)、(3.53±0.61)、(3.37±0.51)mm]、肺主动脉内径[MPAD,(32.87±3.62)、(28.93±2.12)、(28.44±2.71)mm]组间比较差异均有统计学意义(F=5.36、12.91、37.08、23.33,P均<0.01),且青藏高原组均高于黄土高原组和平原组(P均<0.05),黄土高原组的RVTD高于平原组(P<0.05)。青藏高原组、黄土高原组和平原组的右室面积变化分数[FAC,(24.85±2.75)%、(26.26±3.42)%、(26.73±3.14)%]、三尖瓣收缩期位移[TAPSE,(12.87±1.12)、(14.59±1.63)、(14.13±1.31)mm]组间比较差异均有统计学意义(F=3.36、13.47,P<0.05或<0.01),且青藏高原组均低于黄土高原组和平原组(P均<0.05)。青藏高原组、黄土高原组和平原组的右室Tei指数(0.87±0.18、0.78±0.16、0.71±0.14)、三尖瓣舒张早期最大充盈速度/三尖瓣环舒张早期峰值速度[E/E′,9.48±1.22、8.64±0.91、8.12±1.13]、肺动脉收缩压[SPAP,(49.58±11.76)、(44.35±11.41)、(42.67±12.13)mmHg,1mmHg=0.133kPa]组间比较差异均有统计学意义(F=12.89、13.99、3.12,P<0.01或<0.05),且青藏高原组右室Tei指数、E/E′均高于黄土高原组和平原组(P均<0.05),黄土高原组的Tei指数、E/E′高于平原组(P�Objective To analyze the difference of echocardiography in patients with chronic Keshan disease (CKD) at different altitudes areas, explore the effects of altitude on the structure and functional of right heart in CKD patients, and provide a reference for imaging diagnosis of CKD. Methods According to the three step distribution of the terrain in China, 30 cases of CKD patients in the first step (altitude > 4 000 m) of Tibet autonomous region were randomly selected as the Tibetan plateau group. In the second step (altitude: 1 000-2 000 m), 31 cases were randomly selected in Gansu Province as the Loess plateau group. In the third step(altitude < 500 m), 42 cases were randomly selected in Shandong Province as the plain group. Echocardiography was used to analyze the morphology, hemodynamics and function of right heart. Results Right atrial transverse diameter (RATD), right ventricular transverse diameter (RVTD), right ventricular lateral wall thickness (RVWT) and main pulmonary artery diameter (MPAD) of the Tibetan plateau group, the Loess plateau group and the plain group (mm: 49.75 ± 8.40, 45.64 ± 7.63, 43.56 ± 7.34;50.89 ± 7.13, 46.56 ± 5.62, 43.27 ± 6.01;4.75 ± 1.02, 3.53 ± 0.61, 3.37 ± 0.51;32.87 ± 3.62, 28.93 ± 2.12, 28.44 ± 2.71) were significant differences among the three groups (F = 5.36, 12.91, 37.08, 23.33, P < 0.01). The above indexes of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P < 0.05). RVTD of Loess plateau group was higher than that of plain group (P < 0.05). The fractional area change [FAC,(24.85 ± 2.75)%,(26.26 ± 3.42)%,(26.73 ± 3.14)%], tricuspid annular plane systolic excursion [TAPSE,(12.87 ± 1.12),(14.59 ± 1.63),(14.13 ± 1.31) mm] of the Tibetan plateau group, the Loess plateau group and the plain group were significant differences among the three groups (F = 3.36, 13.47, P < 0.05 or < 0.01);the above indexes of the Tibetan plateau group were lower than those of the Loess plateau group and the plain group (P < 0.05). Te

关 键 词：海拔 克山病 右心功能 超声心动描计术 

分 类 号：R542[医药卫生—心血管疾病]