上腔静脉血流频谱参数对儿童肺动脉高压的诊断价值  

Diagnostic Value of Superior Vena Cava Blood Flow Spectrum Parameters in Children with Pulmonary Hypertension

作　　者：姚桃月 刘倩君 胡原[1] 周梦洁[1] 李文凤 刘金桥[1] YAO Tao-yue;LIU Qian-jun;HU Yuan(Department of Ultrasound,Hunan Children's Hospital,Changsha Hunan 410007)

机构地区：[1]湖南省儿童医院超声科,湖南长沙410007

出　　处：《医学临床研究》2022年第9期1299-1302,1306,共5页Journal of Clinical Research

基　　金：湖南省卫生计生委科研计划课题项目(编号:20180459,2020SK50515)。

摘　　要：【目的】探讨上腔静脉(superior vena cava,SVC)血流频谱参数对儿童肺动脉高压(pulmonary hypertension,PAH)的诊断价值。【方法】选取2019年9月至2022年5月在本院经心导管测压确诊的49例PAH患儿(PAH组);另外,选取同期在本院体检的15例健康儿童(对照组),所有受试者均行经胸超声心动图检查,收集SVC血流频谱曲线,采用受试者工作特征(ROC)曲线评估SVC血流频谱参数对PAH的诊断价值。【结果】对照组SVC血流频谱均显示为四相波[收缩期向心波(S波)、舒张期向心波(D波)、收缩末期离心波(VR波)、心房收缩末期离心波(AR波)];PAH组44例四相波,5例非四相波。PAH组AR波峰值流速、VR波峰值流速、AR/S均较对照组均明显升高(P<0.05),两组S波峰值流速、D波峰值流速及AR/D、VR/S、VR/D比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示:AR/S的曲线下面积为0.812,对PAH的诊断效能最好;当AR/S截断值取0.43时,诊断PAH的敏感性为68.00%,诊断中重度PAH的敏感性为74.00%。【结论】SVC血流频谱变化可反映PAH变化,其中AR/S对PAH,尤其是对中重度PAH有一定诊断价值,在三尖瓣反流量不明显或需要更多超声支持时,可成为临床诊断儿童PAH的有效参考指标。【Objective】To investigate the diagnostic value of superior vena cava(SVC)blood flow spectrum parameters in children with pulmonary hypertension(PAH).【Methods】From September 2019 to May 2022,49 patients with PAH diagnosed by cardiac catheterization in our hospital(PAH group)were selected;In addition,15 healthy children(control group)who were examined in our hospital at the same time were selected.All subjects were examined by transthoracic echocardiography,collected the SVC blood flow spectrum curve,and evaluated the diagnostic value of SVC blood flow spectrum parameters for PAH using the subject's work characteristic(ROC)curve.【Results】The SVC spectrum of the control group showed four phase wave[Systolic concentric wave(S wave),diastolic concentric wave(D wave),late systolic centrifugal wave(VR wave),and atrial late systolic centrifugal wave(AR wave)];In the PAH group,44 patients had four phase waves and 5 patients had non four phase waves.The peak velocity of AR wave,the peak velocity of VR wave,and AR/S in the PAH group were significantly higher than those in the control group(P<0.05).The peak velocity of S wave,the peak velocity of D wave,and AR/D,VR/S,VR/D in the two groups had no significant difference(P>0.05).The ROC curve analysis showed that the area under the AR/S curve was 0.812,which was the best for the diagnosis of PAH;When AR/S cut-off value was 0.43,the sensitivity of PAH diagnosis was 68.00%,and the sensitivity of moderate and severe PAH diagnosis was 74.00%.【Conclusion】The changes of SVC blood flow spectrum can reflect the changes of PAH.Among them,AR/S has certain diagnostic value for PAH,especially for moderate and severe PAH.When tricuspid regurgitation is not obvious or more ultrasonic support is needed,AR/S can become an effective reference index for clinical diagnosis of PAH in children.

关 键 词：高血压 肺性/影像诊断 腔静脉 上 超声检查 

分 类 号：R725.441.6[医药卫生—儿科]