儿童超声心动图测量指标正常参考值的建立及临床意义

目的 建立儿童超声心动图测量指标的正常参考值,分析0～16岁儿童心肌质量、心脏大小正常值随体表面积变化的规律,为儿童心脏疾病的诊治提供依据.方法 回顾性分析深圳市儿童医院800名0～16岁体检正常儿童的超声心动图,其中男488名,女312名.对所有受试儿童心脏进行如下测量:M型测量右心室内径(RVD)、室间隔舒张期厚度(IVSd)、左心室后壁厚度(LVPWd)、室间隔收缩期厚度(IVSs)、左心房内径(LAD);二维法测量主动脉环部内径(ARD)、主动脉窦部内径(ASD)、右心室长径、右心室横径、右心室流出道内径(RVOT);双平面法测量左心房容积(LAV)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV),计算每搏量(SV)、左心室射血分数(LVEF)、心排出量(CO)、心脏指数(CI)、左心室容积指数(LVEDV/体表面积);实时三平面几何法测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV),计算每搏量(SV)、左心室射血分数(LVEF)、心排出量(CO)、心脏指数(CI);测量心肌质量(LV mass),计算左心室质量容积比(LV mass/LVEDV)、心肌质量指数LV mass/体表面积和LV mass/H2.7.测量全部受试儿童的身高(H)、体重(W),计算体表面积.分析各参数与体表面积的相关性以及心肌质量指数LV mass/体表面积、LV mass/H2.7与年龄的相关性.结果 488名男童的年龄为(72.17±49.25)个月,心率为(106.52±22.71)次/min,体表面积为(0.68±0.39)m2,LV mass/体表面积为(44.51±15.23)g/m2,LVEDV为(30.51±20.12)ml,SV为(1.99±0.94)ml,CI为(2.40±0.43)L/(min·m2),LVEF为(68.83±8.93)%,LVEDV/体表面积为(34.98±14.46)ml/m2,LV mass/LVEDV为(1.29±0.30)g/ml,均大于女童的(70.78±49.43)个月、(109.45±20.97)次/min、(0.64±0.37)m2、(44.35±14.03)g/m2、(28.34±18.12)ml、(1.68±0.74)ml、(2.39±0.486)L/(min·m2)、(63.18±9.08)%、(34.89±11.53)ml/m2、(1.27±0.28)g/ml,但差异均无统计学意义(t=0.610、-0.384、0.825、0.263、1.141、1.253、-0.155、1.791、0.031、0.025,P均>0.05).M型超声心动图测量的RVD、IVSd、LVPWd、IVSs、LAD与体表面积均呈线性相关(R2=0.802、0.683、0.690、0.715、0.824,P均=0.000),且各年龄段均为RVD/LVD>1:3,IVS/LVPW<1.30,LAD/ASD为0.9～1.24;二维超声心动图测量的ARD、ASD、右心室长径、右心室横径、RVOT和双平面法测量的LAV、LVEDV、LVESV、SV、CO及实时三平面几何法测量的LVEDV、LVESV、SV、CO与体表面积均呈线性相关(R2=0.898、0.919、0.298、0.655、0.910、0.845、0.938、0.911、0.934、0.877、0.937、0.915、0.922、0.873,P均=0.000);双平面法及实时三平面几何法测得的LVEF和CI与体表面积均无相关性(R2=-0.145、-0.033、-0.080、-0.057,P均>0.05).LV mass增长与体表面积呈线性相关(R2=0.926,P=0.000);LV mass/LVEDV不随体表面积而变化(R2=-0.263,P=0.100);LV mass/体表面积不随年龄而变化(R2=-0.432,P=0.111);LV mass/H2.7与年龄具有相关性,0～1岁儿童LV mass/H2.7为(45.92±8.04)g/m2,1～3岁为(40.10±8.33) g/m2,3～6岁为(30.90±6.60) g/m2,6～9岁为(23.88±5.55) g/m2,9～16岁为(23.97±3.80)g/m2.实时三平面几何法测量的LVEDV为(28.87±20.48)ml,LVESV为(10.39±7.93)ml,SV为(18.26±12.47)ml,LVEF为(1.78±1.00)%,CO为(64.80±4.68)L/min,CI为(2.72±0.67)L/(min·m2),与双平面法测量的(29.13±20.37)ml、(10.24±7.54)ml、(18.88±13.14)ml、(1.81±1.03)%、(64.76±4.78)L/min、(2.77±0.69)L/(min·m2)比较差异均无统计学意义(t=-0.198、0.298、-0.741、-0.460、0.131、-1.254,P均 >0.05).结论 儿童超声心动图M型、二维法、双平面法及实时三平面几何法测量结果与儿童体表面积间有一定的规律,可用于儿童心脏病超声心动图诊断的正常参考值,对儿童心脏疾病的诊治具有重要意义.

New reference values for echocardiography dimensions of 800 healthy chinese infants and children

Objective To measure the normal reference values in pediatric echocardiography,analyze the change of myocardial mass and heart size with the variation of body surface area（BSA）,to provide basis for diagnosis and treatment of pediatric heart disease.Methods Echocardiography data from 800 normal pediatric subjects（age：0-16 years old,male：488;female：312）were retrospectively analyzed.The parameters measured are as follows：M-mode measurements for right ventricular diameter（RVD）,interventricular septum diastolic thickness（IVSd）,left ventricular posterior wall thickness（LVPWd）,systolic septal thickness（IVSs）,left atrial diameter（LAD）;Two-dimensional measurement for the aortic rings department（ARD）diameter,aortic sinus diameter（ASD）,right ventricular diameter,right ventricular diameter,right ventricular outflow tract diameter（RVOT）;Two-plane measurement of left atrial volume（LAV）,left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,stroke volume calculated（SV）,left ventricular ejection fraction（LVEF）,cardiac output（CO）,cardiac index（CI）,left ventricular volume index（LVEDV/BSA）;real-time three plane geometry measurement of left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,stroke volume calculated（SV）,left ventricular ejection fraction（LVEF）,cardiac output（CO）,cardiac index（CI）;myocardial mass（LV mass）,volume ratio of left ventricular mass（LV mass/LVEDV）,myocardial mass index,LV mass/BSA and LV mass/H2.7 were measured and calculated.Measurement of height（H）,weight（W）and calculated BSA.Analysis of all the parameters associated with the BSA,and the relationship between myocardial mass index and age.Results The following parameters were higher in 488 male subjects than in femaleage：（72.17±49.25）months vs（70.78±49.43）months;heart rate：（106.52±22.71）/min vs（109.45±20.97）/min;BSA：（0.68 ± 0.39）m2 vs（0.64±0.37）m2;LV mass/BSA：（44.51±15.23）g/m2 vs（44.35±14.03）g/m2;LVEDV：（30.51±20.12）ml vs（28.34±18.12）ml;SV：（1.99±0.94）ml vs（1.68±0.74）ml;CI：（2.40±0.43） L/（min·m2）vs（2.39±0.486）L/（min·m2）;LVEF：（68.83±8.93）% vs（63.18±9.08）%;LVEDV/BSA：（34.98±14.46） ml/m2 vs（34.89±11.53）ml/m2;LV mass/LVEDV：（1.29±0.30）g/ml vs（1.27±0.28）g/ml].But the difference was not statistically significant（t=0.610,-0.384,0.825,0.263,1.141,1.253,1.141,1.253,-0.155,1.791,0.031,0.025,all P0.05）.M-mode echocardiography measurements of RVD,IVSd,LVPWd,IVSs,LAD showed a linear correlation with BSA（R2 = 0.802,0.683,0.690,0.715,0.824,all P=0.000）,and all ages are RVD/LVD1：3,IVS/LVPW1.30,LAD/ASD 0.9 to 1.24;ARD,ASD,right ventricular diameter,RVOT（by two-dimensional echocardiography measurement）and LVEDV,LVESV,SV,CO（by dual-plane method or real-time three plane geometry measurement）showed a linear correlation with BSA（R2 = 0.898,0.919,0.298,0.655,0.91,0.938,0.911,0.934,0.877,0.937,0.915,0.922,0.873,all P=0.000）;LVEF and CI measured by dual-plane method or real-time three plane geometry had no correlation with BSA（R2 =-0.145,-0.033,-0.08,-0.057,all P0.05）.LV mass and BSA showed a linear correlation（R2=0.926,P=0.000）;LV mass/LVEDV does not change with BSA（R2 =-0.263,P=0.100）;LV mass/BSA does not correlated with age（R2=-0.432,P=0.111）;children aged 0 to 1：LV mass/H2.7 is2.7 to（45.92±8.04）g/m2,1-3 years old：（40.10±8.33）g/m2,3-6 years old：（30.90±6.60）g/m2,6-9 year old：（23.88±5.55）g/m2,9-16 years：（23.97±3.80）g/m2.Real-time three plane geometry for the measurement of LVEDV is（28.87±20.48）ml,LVESV is（10.39±7.93）ml,SV is（18.26±12.47）ml,LVEF is（1.78±1.00）%,CO is（64.80± 4.68）L/min,CI is（2.72±0.67）L/（min·m2）;with two-plane measurement of（29.13±20.37）ml,（10.24±7.54）ml,（18.88±13.14）ml,（1.81±1.03）%,（64.76±4.78）L/min and（2.77±0.69）L/（min·m2）.But the difference by the above two methods was not statistically significant（t=-0.198,0.298,-0.741,-0.460,0.131,-1.254,all P0.05）.Conclusions The parameters measured by M-mode,two-dimensional method,double-plane method and real-time measurement of plane geometry in pediatric echocardiography showed certain rules,as a normal reference value.It is important for diagnosis and treatment of pediatric heart disease.