实时三维超声心动图及二维斑点追踪显像对病毒性心肌炎患儿预后的预测价值  

Prediction value of real⁃time three⁃dimensional echocardiography and two⁃dimensional speckle tracking imaging for prognosis of children with viral myocarditis

作　　者：林敏[1] 翁斌[1] 林晟[1] 郭仁铭 陈伟莉 王世彪[1] LIN Min;WENG Bin;LIN Sheng;GUO Renming;CHEN Weili;WANG Shibiao(Department of Pediatric Intensive Care Medicine,Fujian Children's Hospital,Fuzhou 350001,China)

机构地区：[1]福建省儿童医院(上海儿童医学中心福建医院)重症医学科,福建医科大学妇儿医学院,福州350001

出　　处：《中国循证儿科杂志》2023年第6期429-434,共6页Chinese Journal of Evidence Based Pediatrics

基　　金：2022年福建省自然科学基金项目:2022J011072;福建省妇幼保健院科技创新启动基金(科室重点项目):妇幼YCXZ 18-17。

摘　　要：背景实时三维超声心动图及二维斑点追踪显像联合用于评价病毒性心肌炎(VMC)患儿的左心室收缩同步性的相关研究仍较少。目的探讨实时三维超声心动图及二维斑点追踪显像对VMC患儿预后的预测价值。设计回顾性队列研究。方法以福建省儿童医院病历系统中2019年1月至2022年1月住院的确诊VMC患儿为队列人群,以出院后半年为随访终点,根据随访结局分为预后不良组和预后良好组,两组人群进一步按照7∶3的比例分别分为训练集和验证集。患儿入院后均给予常规治疗方案,均行2D-STI[取左心室长轴的心尖两腔切面、心尖四腔切面、心尖切面及左心室后壁短轴的乳头肌切面,测量左心室各壁中间段(MID)、心尖段(APX)、基底段(BAS)的左心室壁各节段舒张晚期峰值应变率(Asr)、收缩期峰值应变率(Ssr)、收缩期峰值应变(ε)、舒张早期峰值应变率(Esr)]及RT-3DE参数[左心室16节段、12节段的收缩末期最小容积时间的最大差值(Tmsv-16-Dif、Tmsv-12-Dif)、标准差(Tmsv16-SD、Tmsv12-SD)及其心率校正值(Tmsv16-SD%、Tmsv12-SD%、Tmsv12-Dif%、Tmsv12-Dif%)]的测量,取两位超声医生测量的平均值。以训练集VMC患儿入院时的2D-STI、RT-3DE参数和实验室检查指标,通过单因素分析、Lasso和Logistic回归分析筛选预测因素,构建预测VMC患儿预后的模型并验证。主要结局指标2D-STI参数及RT-3DE参数对VMC患儿预后的预测价值。结果157例VMC患儿进入本文分析,男82例,女75例;中位年龄6.7(3.2,10.6)岁;中位随访时长8.3(7.4,11.4)个月。预后良好组121例(训练集84例,验证集37例);预后不良组36例(训练集26例,验证集10例)。最终纳入19个影响VMC预后的独立因素,分别为(1)左心室壁长轴方向2D-STI参数:后壁-BAS-ε、下壁-BAS-ε、前壁-MID-Esr、后壁-BAS-Esr、下壁-BAS-Esr、下壁-APX-ε、后壁-APX-Esr、下壁-APX-Esr;(2)RT-3DE参数:Tmsv12-SD、Tmsv12-SD%、Tmsv12-Dif%、TmsvBackground There were still few studies on the combination of real⁃time three⁃dimensional echocardiography(RT⁃3DE)and two⁃dimensional speckle tracking imaging(2D⁃STI)in evaluating left ventricular systolic synchronization for children with viral myocarditis(VMC).Objective To evaluate the value of RT⁃3DE and 2D⁃STI in predicting the prognosis of children with viral myocarditis.Design Retrospective cohort study.Methods A cohort of VMC children hospitalized in Fujian Children's Hospital from January 2019 to January 2022 was collected.The patients were followed up for half a year after discharge taken as the end point.According to the follow⁃up,the patients were divided into poor prognosis group and good prognosis group.The two groups were further divided into training set and verification set according to the proportion of 7∶3 by random number table.After admission,all the children were given routine treatment.Two physicians used the same ultrasound equipment to perform 2D⁃STI that the apical two⁃chamber section,apical four⁃chamber section,apical section and papillary muscle section of the short axis of the left ventricular posterior wall were examined to measure the peak late diastolic strain rate(Asr),systolic peak strain rate(Ssr),systolic peak strain rate(ε),early diastolic peak strain rate(Esr)in middle segment(MID),apical segment(APX)and basal segment(BAS)of left ventricular wall.RT⁃3DE parameters were also measured including maximum difference of minimum end⁃systolic volume time of 16 and 12 segments of left ventricle(Tmsv⁃16⁃Dif,Tmsv⁃12⁃Dif),measurement of standard deviation(Tmsv16⁃SD,Tmsv12⁃SD)and heart rate correction(Tmsv16⁃SD%,Tmsv12⁃SD%,Tmsv16⁃Dif%,Tmsv12⁃Dif%).Each ultrasound physician repeated the measurement for 3 times to take the average value.According to the 2D⁃STI,RT⁃3DE parameters and laboratory indexes of VMC children on admission,the predictive factors were screened by univariate analysis,Lasso and logistic regression analysis,and a model f

关 键 词：实时三维超声心动图 二维斑点追踪显像 病毒性心肌炎 患儿 预后 

分 类 号：R725.4[医药卫生—儿科]