实时三维超声心动图对川崎病患儿左心室功能的评价

Real-time three dimensional echocardiography-based evaluation of left ventricular function in children with Kawasaki disease

摘要:

目的 探讨实时三维超声心动图（RT-3DE）全容积成像技术在评价川崎病（Kawasaki disease，KD）患儿左心室整体和局部收缩功能中的应用价值。方法 73 例KD 患儿（无冠状动脉病变33 例、冠状动脉病变40 例）与35 例正常对照儿童进行M 型超声及RT-3DE 全容积成像技术测量左室射血分数（LVEF）；计算左室容积-时间曲线和节段的速度-时间曲线，比较无冠状动脉病变组、冠状动脉病变组及正常组间的各项指标。结果 常规M 型超声测量显示，冠状动脉病变组LEVF 低于无冠状动脉病变组和对照组（P<0.05），而无病变组和对照组间差异无统计学意义（P>0.05）。RT-3DE 测量的LEVF 3 组间两两比较差异均有统计学意义（P<0.05），其中冠状动脉病变组最低，无病变组次之，正常组最高。RT-3DE 室壁节段性分析：冠状动脉病变组Tmsv16-SD、Tmsv12-SD 均较无冠状动脉病变组和正常组增高（P<0.05），且Tmsv6-SD 高于正常组（P<0.05）；无冠状动脉病变组Tmsv16-SD 较正常组增高（P<0.05）。结论 应用RT-3DE 全容积成像技术可以定量评价KD 患儿左心室整体和局部功能；此技术可为临床定量评价左心室整体、局部功能及心室协调性提供一种可行且准确的新方法。

Abstract:

Objective To evaluate the clinical significance of full volume real-time three-dimensional echocardiography (RT-3DE) in the assessment of general and local systolic functions of the left ventricle in children with Kawasaki disease (KD). Methods A total of 73 KD children (40 with and 33 without coronary artery lesions) and 35 healthy control children were recruited. Left ventricular ejection fraction (LVEF) was measured by M-mode ultrasound and full volume RT-3DE imaging. A left ventricular volume-time curve and a segmental speed-time curve were generated. Differences between control subjects and patients with and without coronary artery lesions were analyzed. Results The M-mode ultrasound measurements of LVEF in KD patients with coronary artery lesions were significantly lower than in KD patients without coronary artery lesions and control children (P<0.05), while there was no significant difference between KD patients without coronary artery lesions and control children. RT-3DE measurements of LVEF were significantly different between the three groups analyzed (P<0.05): coronary artery lesion group < no coronary artery lesion group < control group. RT-3DE-based segmental ventricular wall analysis revealed that Tmsv16-SD and Tmsv12-SD in KD patients with coronary artery lesions were significantly higher than other two groups and Tmsv6-SD was also significantly higher than in the normal control group (P<0.05) and that Tmsv16-SD in KD patients without coronary artery lesions increased significantly compared with the normal control group (P<0.05). Conclusions RT-3DE can be used in the quantitative evaluation of the left ventricular function and therefore has significant clinical implications.