应用组织多普勒成像评价低月龄婴儿川崎病左室功能变化

王海永; 童明辉; 吴婷婷; 雷海燕; 王佳冰

应用组织多普勒成像评价低月龄婴儿川崎病左室功能变化

The evaluation of left ventricular function change in younger infants with Kawasaki disease by Tissue doppler imaging

摘要

摘要: 目的探讨组织多普勒成像（tissue doppler imaging,TDI）在评价低月龄婴儿川崎病(Kawasaki disease,KD)左室功能变化的特点。方法连续选取住院KD患者125例，分为≤6个月组（n=28)和>6个月组(n=97)。于静脉注射免疫球蛋白（intravenous immunoglobulin,IVIG）前、IVIG后6周、IVIG后12周用TDI分别获得二尖瓣瓣环室间隔侧及左室侧壁处舒张早期运动速度e’sep、e’lat；室间隔处TDI-Tei指数,并对不同时期二组之间及同组间不同时间点参数做比较。结果 ≤6个月组冠状动脉损伤发生率高于>6个月组（32% vs. 24%），且损伤程度较重。IVIG前≤6个月组e’lat、e’sep均显著低于>6个月组，E/e’lat、E/e’sep均显著高于>6个月组（均P<0.01）。IVIG后6周≤6个月组e’lat、e’sep略有恢复，但仍低于>6个月组，E/e’lat、E/e’sep下降但仍高于>6个月组（均P<0.05），IVIG后12周≤6个月组e’lat、e’sep与>6个月组相比无显著差别，E/e’sep进一步减低但仍高于>6个月组（P<0.05）。IVIG前、IVIG后6周≤6个月组TDI-Tei指数均高于>6个月组（均P<0.05），而在IVIG后12周，该指标两组间无显著差别。≤6个月组与IVIG前相比，IVIG后12周e’lat、e’sep及E/A显著升高，E/e’sep及TDI-Tei指数显著下降（均P<0.05）。与IVIG后6周相比，IVIG后12周e’sep进一步显著升高，TDI-Tei指数进一步显著下降（均P<0.05），但IVIG前与IVIG后6周相比，各参数未见显著差异，>6月组各时间点参数未见显著差异。结论与大龄KD患者相比,低月龄KD婴儿冠状动脉损伤发生率较高且程度较重，左室舒张功能减低明显，且恢复时间长。

Abstract: AIM To observe the characteristics in younger infants with KD by TDI. METHODS 125 KD patients were consecutively selected, and divided into two groups, ≤6 months group and >6 months group. 28 cases were included in the ≤6 months group, while 97 cases were in the >6 months group. The e’sept (the mitral annular velocity of septal during early diastolic period), e’lat (the mitral annular velocity of lateral left ventricle during early diastolic period) and septal TDI-Tei index (the sum of the isovolumetric contraction and relaxation times divided by the ejection time) in before IVIG administration, 6 weeks after IVIG administration, and 12 weeks after IVIG administration were measured by TDI, and were compared with each other during different phases. RESULTS ≤6 months group had a higher incidence of coronary artery lesions than >6 months group (32% vs. 24%), and the damage degree was more serious. ≤6 months group had a much lower value of e’lat and e’sep and a much higher value of E/e’lat and E/e’sep than group B in the first two phases (P<0.05). There were no significant differences in e’lat and e’sep between the two groups in the last phase, but a higher value of E/e’sep in ≤6 months group (P<0.05). There was a higher TDI-Tei index in ≤6 months group than >6 months group during the first two phases (P<0.05), and no signficant difference in the last phase. In ≤6 months group, compared to before IVIG administration, e’lat, e’sep, E/A, E/e’lat, E/e’sep and TDI-Tei index of 12 weeks after IVIG administration begun to recover (P<0.05), but there was no significant difference between the time before IVIG administration and the time of 12 weeks after IVIG administration. In >6 months group, there were no significant differences among the three phases. CONLUSION There is a high incidence of coronary artery lesions in younger infants, and the degree of injury can be more serious. The left ventricular diastolic function of such patients can significantly decrease and the recovery time is longer. With the significantly early rise in E/e’sept, E/e’lat, TDI-Tei index may be used to assist in the diagnosis of such disease.

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