Abstract: Objective　To explore the value of tricuspid annular plane systolic excursion （TAPSE） for evaluation of right ventricular function in children with high altitude heart disease. Methods　A total 21 children with high altitude heart disease （HAHD） admitted to the Peoples Hospital of Tibet Autonomous Region from August 2017 to August 2018 were divided into mild-to-moderate heart failure group （n=13） and severe heart failure group （n=8） according to modified ROSS heart failure score，and 14 healthy children receiving echocardiography because of heart murmur coming from the same district served as control group. All children underwent the routine echocardiography. Their right ventricular outflow tract （RVOT），right ventricular anterior wall （RVAW），tricuspid regurgitation jet velocity and respiration variations of inferior vena cava were determined. Tricuspid annular plane systolic excursion（TAPSE）was measured through M-mode echocardiography. Serum brain natriuretic peptide （BNP） was detected by ELISA. Results　（1） Compared with control group，RVOT was significantly increased，RVAW was significantly thickened，while TAPSE significantly decreased in patients with HAHD （P＜0.05，respectively）. （2） There was no significant difference in RVOT，RVAW or pulmonary artery systolic pressure （PASP） between mild-to-moderate heart failure group and severe heart failure group（P＞0.05）. However，compared with mild-to-moderate heart failure group，serum BNP significantly increased，and TAPSE significantly decreased in severe heart failure group （P＜0.05，respectively）. （3）Spearman correlation analysis showed a negative correlation between TAPSE and modified ROSS heart failure score，PASP，and BNP （r=-0.517、-0.718 and -0.749，all P＜0.05，respectively）. Conclusion　TAPSE is a simple，workable and repeatable method to evaluate right ventricular function in children with HAHD，and has a favorable clinical significance for the diagnosis and assessment of severity of HAHD in children.

Key words: high altitude heart disease, child, right ventricular function, echocardiography

摘要： 目的　探讨三尖瓣环收缩期位移对高原性心脏病婴幼儿的右心室功能的价值。方法　2017年8月至2018年8月间到西藏自治区人民医院儿科住院的临床诊断为高原性心脏病的患儿21例，根据患儿心功能改良ROSS评分，将患儿分为轻中度心衰组（13例）及重度心衰组（8例），同期来自上述地区因心脏杂音行超声心动图检查的健康婴幼儿（14例）作为对照组。超声常规测量右心室横径，右心室前壁厚度，三尖瓣返流最大返流速度，下腔静脉吸气塌陷率，及应用M型超声测量右心室游离壁三尖瓣环收缩期位移（TAPSE）。采用酶联免疫法测定患儿的血清脑钠肽浓度。结果　（1）与正常对照组相比，高原性心脏病组患儿右室流出道内径显著增大，右心室前壁厚度显著增厚，差异均有统计学意义（P＜0.05）；高原性心脏病患儿的TAPSE则显著低于对照组婴幼儿，差异均有统计学意义（P＜0.05）；（2）与轻中度心衰婴幼儿相比较，重度心衰患儿的右室流出道内径，右心室前壁厚度及肺动脉压力差异无统计学意义（P＞0.05），但血清BNP浓度在重度心衰的患儿显著高于轻中度心衰患儿，差异具有统计学意义（P＜0.05），而TAPSE 在重度心衰患儿则显著低于轻中度心衰患儿，具有统计学意义（P＜0.05）；（3）采用spearman相关分析发现，TAPSE与婴幼儿心力衰竭ROSS评分、PASP及BNP均呈较好的负相关，相关系数r值分别为-0.517、-0.718及-0.749，P值均＜0.05。结论　TAPSE可作为临床评价高原性心脏病婴幼儿的右心室功能提供一个简单、可操作性强、可重复性好的新方法。为协助诊断及评估高原性心脏病患儿的严重程度具有重要意义。

关键词: 高原性心脏病, 儿童, 右心室功能, 超声心动图