中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (2): 115-119.

• 论著 • 上一篇    下一篇

超声新指标和脑利钠肽评估小儿室间隔缺损
合并肺动脉高压右室功能损害价值分析

徐秋琴，严文华，丁粤粤，周万平，吕海涛，黄    洁   

  1. 苏州大学附属儿童医院心内科，江苏苏州    215003
  • 出版日期:2012-02-06 发布日期:2012-04-12

Clinical evaluation of right ventricular function in children with ventricular septal defect complicated by pulmonary artery hypertension. 

  • Online:2012-02-06 Published:2012-04-12

摘要：

目的    探讨组织多普勒（TDI）、二维斑点追踪技术（STI）和血清脑利钠肽（BNP）评估室间隔缺损（VSD）合并不同程度肺动脉高压（PH）患儿右心室功能的价值。方法    2008年6月至2010年6月在苏州大学附属儿童医院住院的VSD合并PH患儿68例，根据三尖瓣反流压差测得肺动脉压力程度分为轻度组（23例）、中度组（21例）、重度组（24例）。同时选择24名健康体检者作为正常对照组。采用GE VIVID7仪器测量右室长轴整体收缩期应变（GLS）和应变率（GLSR），三尖瓣环脉冲组织多普勒图测量三尖瓣环收缩期峰值速度（Sa）、等容收缩加速度（IVA）、Tei指数，用M型超声测量三尖瓣环收缩期位移（TAPSE）。采用ELIASA法测血清脑钠钛（BNP）浓度。结果    （1） IVA和TAPSE随着PAH升高而降低，而Tei指数随着PAH增加而增大，3个指标除正常对照组和轻度组间差异无统计学意义外（P > 0.05），其他各组间差异均有统计学意义（P < 0.05）。Sa在中、重度组间差异无统计学意义（P > 0.05），在正常对照、轻度组间差异无统计学意义（P > 0.05），其余组间有统计学意义（P < 0.05）。（2）右室GLS、GLSR随着PAH升高而减小，GLS在4组间两两比较差异有统计学意义（P < 0.05）；GLSR中度和重度组与正常对照组和轻度组差异有统计学意义（P < 0.05），中重度间及正常对照组和轻度间差异无统计学意义（P>0.05）。（3）血清BNP浓度在VSD组中随着PAH程度的加重而升高，在4组间两两比较差异有统计学意义（P < 0.05）。（4）BNP与Tei指数及心功能分级相关性最好。结论    TDI和STI各个参数均能反映VSD合并PH患儿右心室功能，其中BNP和Tei指数与心功能相关性最好，而BNP和GLS可以反映轻度PAH时右室功能受损。

关键词: 心脏病, 先天性, 肺动脉高压, Tei指数, 脑利钠肽

Abstract:

Objective    Discuss the value of TDI， STI and serum BNP in evaluating right ventricular function in children with VSD complicated by pulmonary artery hypertension （PAH）. Methods    A total of 68 children with VSD and 24 age-matched healthy children were involved in this research. The patients were divided into mild（n=23）， moderate（n=21） and severe（n=24） groups according to pulmonary artery pressure. Two-dimensional standard apical four-chamber image of consecutive three cardiac cycles were preserved by GE Vivid 7 to obtain GLS and GLSR. PW-TDI of tricuspid annulus motion curve was recorded to measure Sa，IVA and Tei. Tricuspid annulus plane systolic excursion（TAPSE） was measured through M-mode echocardiography.BNP was detected by ELIASA. Results    （1） Tricuspid annulus IVA and TAPSE decreased with the increase of PAH， but Tei index increased with the PAH（P < 0.01）.The three parameters had significant difference except those between control group and mild group. Sa had significant difference except that between control group and mild group， moderate and severe group. （2） GLS and GLSR decreased with the increase of  PAH；GLS had statistically significant difference between the groups. GLSR had significant difference except that between control group and mild group， moderate and severe group. （3）Serum BNP increased in accordance with PAH and had significant difference between the groups. （4）BNP and Tei index correlated better with NYHA. Conclusion    TDI and STI parameters can reflect the right ventricular function of children with VSD complicated by pulmonary hypertension. BNP and Tei index correlate  with NYHA better. BNP and GLS can reflect mild impair of the right ventricle.

Key words:  , heart disease； congenital； pulmonary artery hypertension； Tei index； brain natriuretic peptide AT