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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GEVIVID7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。
Objective To investigate the value of tissue Doppler (TDI), two-dimensional speckle tracking (STI) and serum brain natriuretic peptide (BNP) in assessing right ventricular function in patients with ventricular septal defect (VSD) complicated with pulmonary hypertension (PH) Methods Sixty-eight patients with VSD and PH who were hospitalized at Children’s Hospital Affiliated to Soochow University from June 2008 to June 2010 were divided into mild group (n = 23) according to tricuspid regurgitation pressure difference Degree group (21 cases), severe group (24 cases). At the same time, 24 healthy people were selected as normal control group. The total systolic strain (GLS) and strain rate (GLSR) of the long axis of the right ventricle were measured by GEVIVID7 instrument. The tricuspid annulus systolic peak velocity (Sa), isovolumeral systolic acceleration IVA), Tei index, tricuspid annulus systolic displacement (TAPSE) measured by M-mode ultrasound. Serum brain sodium and titanium (BNP) concentrations were measured by ELIASA. Results (1) The IVA and TAPSE decreased with the increase of PAH, while the Tei index increased with the increase of PAH. There was no significant difference among the three indexes except the normal control group and the mild one (P> 0.05) The differences among the other groups were statistically significant (P <0.05). There were no significant differences in Sa between the moderate and severe groups (P> 0.05). There was no significant difference between the normal control group and the mild group (P> 0.05). The other groups were statistically significant (P <0.05). (2) The GLS and GLSR of the right ventricle decreased with the increase of PAH, and there was a significant difference of GLS among the four groups (P <0.05); in the GLSR moderate and severe group, The difference was statistically significant (P <0.05), moderate and severe and normal control group and mild difference was not statistically significant (P> 0.05). (3) Serum BNP levels increased with the severity of PAH in VSD group, and there was a significant difference between the 4 groups (P <0.05). (4) The correlation between BNP and Tei index and cardiac function classification is the best. Conclusion All parameters of TDI and STI can reflect the right ventricular function in patients with VSD complicated with PH. The correlation between BNP and Tei index and cardiac function is best, while BNP and GLS can reflect the impairment of right ventricular function in mild PAH.