二维斑点追踪成像技术在甲型流感相关心肌炎患儿左室功能评估中的价值

doi:10.12372/jcp.2024.23e0710

摘要/Abstract

摘要：

目的探讨二维斑点追踪成像技术在评估甲型流感相关心肌炎患儿左室功能和室壁运动障碍中的价值。方法选取30例甲流相关心肌炎患儿作为病例组，门诊正常体检患儿33例作为正常对照组，对其进行常规超声检查，并运用二维斑点追踪技术评价心功能及左室整体纵向应变，进行对比分析。结果 30例心肌炎患儿年龄、体表面积、左心室舒张末期内径（LVIDd）、舒张末期室间隔厚度（IVSd）、舒张早期与舒张晚期二尖瓣血流速度比值（E/A）、CK-MB指标与正常对照组差异无统计学意义（P>0.05），病例组心率、血hsTnI指标高于对照组，左室射血分数LVEF、舒张早期二尖瓣环运动速度的比值（E/E’）以及左室整体收缩期应变峰值（GLPS）均低于对照组，差异有统计学意义（P<0.05）。GLPS与LVEF呈显著的正相关，与IVSd呈显著的负相关，但与LVIDd、E/A、E/E’以及血hsTnI、CK-MB及心电指标相关性不明显。GLPS诊断小儿甲流相关心肌炎的最佳阈值为-19.9 %。结论 2D-STE的左室长轴应变可较准确反映甲流病毒感染所致的心肌炎患儿的左室功能变化，可作为甲流相关心肌炎的早期诊断、随访及预后评估的一种简便安全、可靠的实用新手段。

关键词: 甲型流感病毒, 心肌炎, 二维斑点追踪技术, 儿童

Abstract:

Objective To evaluate left ventricular function and ventricular wall motion disorder by two-dimensional speckle tracking echocardiography (2D-STE) in children with influenza A-related myocarditis. Methods Thirty children with influenza A-related myocarditis were selected as the case group, and 33 children who came in for routine check-ups were used as the normal control group. Routine ultrasonography was performed on both groups, and two-dimensional speckle tracking technology was used to evaluate cardiac function and global longitudinal strain of the left ventricle. Comparative analysis was conducted between the two groups. Results There was no significant difference in age, body surface area, end-diastolic left ventricular diameter (LVIDd), diastolic interventricular septal thickness (IVSd), early diastolic and late diastolic mitral flow velocity ratio (E/A) and CK-MB between the case group and the normal control group (P>0.05). Compared with the normal control group, the heart rate and hsTnI level were higher, and the left ventricular ejection fraction (LVEF), ratio of early diastolic mitral annulus velocity (E/E') and left ventricular global systolic strain peak (GLPS) were lower in the case group, and the differences were statistically significant (P<0.05). GLPS was positively correlated with LVEF and negatively correlated with IVSd, but not significantly correlated with LVIDd, E/A, E/E’, hsTnI, CK-MB and electrocardiographic parameters. The optimal cutoff value of GLPS for the diagnosis of influenza A-related myocarditis in children was -19.9 %. Conclusions Left ventricular long-axis strain of 2D-STE can accurately reflect the changes of left ventricular myocardial mechanical properties in children with myocarditis caused by influenza A virus infection. It can be used as a simple, safe, reliable and practical new means for early diagnosis, follow-up and prognosis evaluation of influenza A-related myocarditis.

Key words: influenza A virus, myocarditis, two-dimensional speckle tracking echocardiography, child

陈晔, 朱善良, 杨世伟, 陈俊, 花立春, 唐颖. 二维斑点追踪成像技术在甲型流感相关心肌炎患儿左室功能评估中的价值[J]. 临床儿科杂志, 2024, 42(7): 648-653.

CHEN Ye, ZHU Shanliang, YANG Shiwei, CHEN Jun, HUA Lichun, TANG Ying. The value of two-dimensional speckle tracking imaging in the assessment of left ventricular function in children with influenza A-related myocarditis[J]. Journal of Clinical Pediatrics, 2024, 42(7): 648-653.

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参考文献 13

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项目	病例组（n=30）	对照组（n=33）	统计量	P
年龄/月	92.7±42.0	88.0±30.9	t=0.41	0.684
体表面积/m²	1.1±0.4	1.0±0.3	t=0.41	0.679
心率/次·min^-1	102.5±15.2	94.7±5.8	t=2.28	0.030
LVIDd/mm	40.6±6.0	40.5±5.6	t=0.03	0.979
IVSd/mm	6.1±1.7	6.0±0.9	t=0.43	0.667
LVEF/%	59.7±5.5	63.7±2.9	t=3.37	0.002
E/A	1.9±0.3	2.0±0.3	t=0.58	0.568
E/E'	8.8±1.3	7.0±0.9	t=5.14	<0.001
GLPS/%	-19.2±3.1	-21.8±1.9	t=3.40	0.001
hsTnI/pg·mL^-1	848.9±3527.9	3.1±1.4	Z=5.40	<0.001
CK-MB/ng·mL^-1	22.5±23.9	14.0±39.2	t=0.90	0.371

节段/%	病例组（n=30）	对照组（n=33）	t值	P
前壁基底段	-17.1±4.0	-17.7±1.8	0.79	0.437
前间隔基底段	-15.7±3.2	-18.4±2.2	3.51	0.001
后间隔基底段	-16.9±6.8	-21.0±4.0	2.61	0.012
下壁基底段	-14.3±10.0	-18.4±4.2	1.94	0.059
后壁基底段	-15.0±4.2	-18.9±4.3	3.03	0.005
侧壁基底段	-17.1±4.5	-20.4±4.0	2.65	0.012
前壁中间段	-19.9±4.2	-22.7±2.2	2.55	0.014
前间隔中间段	-19.5±3.6	-21.9±2.5	2.72	0.009
后间隔中间段	-20.4±4.8	-23.4±3.3	2.60	0.013
下壁中间段	-16.6±6.9	-20.3±4.0	2.33	0.025
后壁中间段	-16.9±3.7	-21.0±2.4	4.20	0.001
前侧壁中间段	-18.5±4.8	-22.3±3.2	3.28	0.002
前壁心尖段	-23.2±4.3	-26.2±4.0	2.42	0.021
室间隔心尖段	-22.8±4.3	-25.3±2.7	2.49	0.017
下壁心尖段	-21.6±4.3	-25.0±4.3	2.69	0.011
侧壁心尖段	-21.4±4.4	-25.4±4.5	3.02	0.005
心尖顶段	-22.3±4.0	-25.3±2.8	3.08	0.004

项目	r值	P
hsTnI	-0.089	0.535
CK-MB	-0.154	0.302
LVEF	0.548	<0.001
E/E’	-0.148	0.320
LVIDd	-0.163	0.273
IVSd	-0.422	0.003
E/A	0.225	0.128
ECG结果	-0.240	0.210

项目	例1	例2	例3
年龄/月	176	126	62
性别	男	男	女
心率/次·min^-1	75	120	119
临床表现	发热、腹泻	胸痛	发热、呕吐
体表面积/m²	1.57	1.36	0.76
心电图（阳性结果）	部分导联T波改变	窦性心律不齐	窦性心动过速
hsTnI/pg·mL^-1	18 906.8	3 025.2	1 463.0
CK-MB/ng·mL^-1	94.3	14.8	20.5
EF/%	52.8	57.5	44.1
LVIDd/mm	43.3	47.6	31.3
IVSd/mm	7.7	6.1	9.7
GLPS/%	-9.1	-9.9	-9.9
预后	好转	好转	好转

项目	第1天（术前）	第6天（术中）	第9天（术后）	第26天（术后）
hsTnI/pg·mL^-1	1 463.0	258.1	26.5	23.7
CK-MB/ng·mL^-1	20.5	2.7	1.8	2.0
EF/%	44.1	59.0	66.0	76.3
LVIDd/mm	31.3	30.5	30	28.4
IVSd/mm	9.7	9.1	8.5	8.3
GLPS/%	-9.9	-12.8	-18.7	-19.9