超重肥胖对8~9岁儿童心脏结构和功能的影响

评价超重、肥胖儿童心脏结构和功能情况,旨在评估心脏早期改变的风险性和不良后果,为加强早期干预和预防成年心血管疾病提供参考.方法 选取北京市海淀区昌平区5所小学的1 034名8~9岁儿童(男514名,女520名),依照BMI分类标准,男、女各分成体重正常组、超重组和肥胖组.对所有受试者进行超声心动图检查,并分性别比较心脏结构和功能指标.结果 与体重正常组儿童相比,肥胖男童主动脉根部内径(AOD)、舒张末期室间隔厚度(IVSd)、左心室舒张末期内径(LVIDd)、舒张末期左室后壁厚度(LVPWd)、左心室舒张末期容积(EDV)、左心室质量(LVM)、每搏量(SV)、心输出量(CO)、左心室质量指数(LVMI)分别增加了6.7%,13.4%,7.6%,15.3%,19.7%,34.6%,18.3%,23.7%,8.8%(P值均<0.01);肥胖女童AOD,IVSd,LVIDd,LVPWd,EDV,LVM,LVMI,SV,CO分别增加了4.9%,9.1%,9.1%,12.1%,22.7%,32.9%,7.3%,22.5%,26.0%(P值均<0.01).超重儿童ADD,LVIDd,IVSd,LVPWd,EDV,LVM,SV,CO均高于体重正常儿童(P值均<0.05).不同BMI儿童射血分数(EF),短轴缩短率(FS)差异均无统计学意义.男童BMI与AOD,IVSd,LVIDd,LVPWd,RWT,EDV,LVM,LVMI,HR,CO,SV呈正相关(r值分别为0.217,0.289,0.288,0.338,0.156,0.291,0.534,0.227,0.173,0.322,0.262,P值均<0.01);女童BMI与IVSd,LVIDd,LVPWd,EDV,LVM,LVMI,CO,SV呈正相关(r值分别为0.146,0.322,0.224,0.329,0.444,0.158,0.288,0.287,P值均<0.01).结论 8~9岁超重儿童即可出现左心室扩大、室壁增厚、左室质量增加、心脏功能异常,并随超重向肥胖过渡而加重,且BMI对男童心脏结构和功能影响更大.

Impacts of overweight and obesity on cardiac structure and function among children

Objective To evaluate the impact of childhood overweight and obesity on cardiac structure and function.Methods A total of 1 034 children (aged between 8-9 years old;520 females) from 5 primary schools in Beijing,dividing into normalweight,overweight and obese group according to the sex and BMI.All the subjects underwent ultrasonic cardiogram for a complete assessment of cardiac structure and function.Results Compared with the normal weight group,obese boy showed increased aortic root dimension (AOD),interventricular septal thickness (IVSd),left ventricular end-diastolic dimension (LVIDd),left ventricular posterior wall thickness (LVPWd),left ventricular end-diastolic volume (EDV),left ventricular mass (LVM),stroke volume (SV),cardiac output (CO),and left ventricular mass index (LVMI) by 6.7%,13.4%,7.6%,15.3%,19.7%,34.6%,18.3%,23.7%,8.8%(P<0.01),while obese girls showed increased AOD,IVSd,LVIDd,LVPWd,EDV,LVM,SV,CO by 4.9%,9.1%,9.1%,12.1%,22.7%,32.9%,22.5%,26.0%.The overweight children showed increased LVPWd,EDV,LVM,SV,CO (P<0.01) compare with normal weight children.No differences in ejection fraction (EF) and fractional shortening (FS) were found between obese/overweight groups with normal weight group.BMI was positively associated with AOD,IVSd,LVIDd,LVPWd,RWT,EDV,LVM,LVMI,HR,CO,SV (r=0.217,0.289,0.288,0.338,0.156,0.291,0.534,0.227,0.173,0.322,0.262,P<0.01) in males,while positive correlations were found between BMI and IVSd,LVIDd,LVPWd,EDV,LVM,LVMI,CO,SV in females (r=0.146,0.322,0.224,0.329,0.444,0.158,0.288,0.287,P<0.01).Conclusion Alterations of cardiac structure and function are significant in overweight and obese boys and girls aged 8-9 years old,including increased left ventricular diameter,wall thickness and left ventricular mass and cardiac dysfunction.