儿童扩张型心肌病心脏无创性检查及其在鉴别诊断中的价值

目的　明确心脏无创性检查在儿童扩张型心肌病 (DCM )的变化及其在DCM与肥厚型心肌病 (HCM )、心内膜弹力纤维增生症 (EFE)鉴别中的价值。方法　对 14 6例DCM、4 1例HCM、5 9例EFE患儿 ,用心电图(EKG)、多普勒超声心动图 (ECHO)、彩色多普勒组织显像 (DTI)检查 ,并与 6 117名正常儿童EKG、2 86名正常儿童多普勒ECHO、14 3名正常儿童DTI检查对比。结果　EKG左室面电压增高者HCM、EFE显著多于DCM。多普勒ECHO检查 :DCM患儿心腔增大 ,左心室后壁 (LVPW )、室间隔 (IVS)不增厚 ;HCM患儿心腔不增大 ,LVPW、IVS增厚 ;EFE患儿心腔扩大 ,LVPW、IVS增厚。多普勒ECHO检查 :DCM和EFE患儿心脏收缩功能降低大于HCM患儿 ;DCM、HCM、EFE患儿心脏舒张功能下降差异无显著性。DTI检查 :HCM、DCM、EFE三者差异无显著性 ,DCM患儿心脏舒张功能降低重于收缩功能降低。DCM患儿MVRDeV <4cm/s者 ,预后极差。结论　EKG、多普勒ECHO、DTI对DCM的诊断和DCM与HCM、EFE的鉴别有重要价值。DTI对估计DCM预后有重要价值。

Cardiac non-traumatic examination and its value in differential diagnosis of dilated cardiomyopathy in children

Objective To study the changes of cardiac non-traumatic examination in children with dilated cardiomypathy (DCM) and its value in making differential diagnosis with hypertrophic cardiomyopathy (HCM) and endocardial fibroelastosis (EFE).Methods One hundred and forty-six cases with DCM,41 cases with HCM and 59 with EFE were examined by EKG,Doppler echocardiography (ECHO) and Doppler tissue image (DTI) and then compared with EKG of 6117 healthy children,Doppler ECHO of 286 healthy children and DTI of 143 healthy children.Results In EKG,the cases with elevated electric voltage of left ventricle were more common in HCM and EFE than in DCM.In ECHO,cardiac chambers were enlarged,left ventricular posterior wall(LVPW) and interventricular septum(IVS) were not thickened in DCM; cardiac chambers were not enlarged,LVPW and IVS were thickened in HCM; cardiac chambers were enlarged,LVPW and IVS were thickened in EFE.In Doppler ECHO,decrease of systolic heart function was more common in DCM and EFE.In DTI,there was no significant difference between DCM,HCM and EFE.Cardiac diastolic function decrease was more common than cardiac systolic function in DCM.The prognosis of DCM with MVRDeV<4cm/s was very poor.Conclusion EKG,Doppler ECHO and DTI examination are of high value in the diagnosis of DCM and in differential diagnosis with HCM and EFE.DTI examination is valuable for in estimating the prognosis of DCM.