学龄儿童肥厚型心肌病彩色多普勒超声心动图特征和规律性研究

目的 探寻学龄儿童肥厚性心肌病（HCM）彩色多普勒超声心动图（CDE）特征和规律性。方法 连续37例学龄儿童HCM患者,同期30例性别年龄体重相近的正常学龄儿童志愿者作为对照组,应用CDE对比观察,寻找HCM患儿CDE特征和规律性。结果 二维超声心动图在胸骨旁左心室长轴切面显示HCM组97.3%患儿室间隔均明显增厚并凸向左心室流出道,67.6%左心室流出道不同程度狭窄,所有患儿左心室内径均有不同程度缩小,32.4%合并左心室后壁增厚。M型超声心动图测量HCM组与对照组数据室间隔厚度为11.8±0.8mm和5.4±0.6mm、左心室内径为34.4±1.4mm和39.8±1.9mm和左心室容积指数为33.3±2.3ml/m²和53.3±2.9ml/m²、左心室射血分数为82.5%±1.7%和65.5%±1.7%,差异有统计学意义（P=0.000）。67.6%显示二尖瓣前叶运动曲线CD段向前运动即SAM征阳性。连续波多普勒估测HCM组跨左心室流出道压力阶差,32.4% < 30mmHg、54.1% 30~49mmHg、13.5% 50~75mmHg。HCM组彩色多普勒流显像于收缩期67.6%显示过左心室流出道五彩镶嵌射流束血流信号,45.9%显示过二尖瓣五彩镶嵌返流束血流信号。结论 学龄儿童HCM的CDE特征和规律性明显,CDE对学龄儿童HCM具有特异性诊断价值,但需要与主动脉瓣狭窄鉴别诊断。

Study on the Characteristics and Regularities of Color Doppler Echocardiography of School-age Children with Hypertrophic Cardiomyopathy

Objective To explore the characteristics and regularities of color Doppler echocardiography (CDE) of school-age children with hypertrophic cardiomyopathy (HCM). Methods We used CDE to observe and compare thirty-seven consecutive cases of school-age children with HCM and the control group made up of 30 normal school-age children volunteers of the same sex, age and similar body weight during corresponding periods, to find out the characteristics and regularities of CDE of children with HCM. The measurement data of M-mode CDE were represented by(x ±s)and verified by statistical t. Results According to the two-dimensional echocardio- graphy of the long-axis view of the parasternal left ventricle, 97.3% children in HCM group had obviously thickened ventricular septum with convex to the left ventricular outflow tract, 67.6% of the left ventricular outflow tracts appeared different degrees of stenosis, the left ventricular diameter of all children was decreased to different degrees and 32.4% of the cases were also accompanied by thickened left ventricular wall. Some data measured by M-mode echocardiography for HCM group and control group: ventricular septum thickness 11.8±0.8mm and 5.4±0.6mm,inner diameter of left ventricle 34.3±1.4mm and 39.8±1.9mm,left ventricular volume index 33.3±2.3ml/m² and 53.3±2.9ml/m²,left ventricular ejection fraction 82.5%±1.7% and 65.5%±1.7%. Verified by statistical t, the difference was significant(P=0.000). In 67.6% cases, the CD segment of the anterior mitral valve leaflet motion curve showed forward movement, in other words, "SAM" positive. Measured by continuous Doppler,the pressure gradients of the left ventricular outflow tract were 32.4%<30mmHg,54.1% 30-49mmHg and 13.5% 50-75mmHg. The color Doppler flow images of HCM group were displayed during the contraction period. 67.6% showed multi-colored jet flow signal of left ventricular outflow tract; 45.9% showed multi-colored regurgitation signal of mitral valves. Conclusion There are obvious characteristics and regularities for CDEs of children with HCM. Therefore, CDE has specific diagnostic value for school-age children with HCM, but differential diagnosis for aortic stenosis should be carried out.