儿科范围内有排异反应的心脏移植接受者的超声心动图评价

目的：为了确定超声心动图左室心功能指标在预测心脏排异方面是否有用。方法：对12例心脏移植接受者（年龄3～17岁）进行了52次超声检查及穿刺活检，并将结果与12名正常少儿（年龄2～17岁）进行对照。组织活检被分为无排异（n=23），轻度排异细胞渗透（n=13），中度排异肌细胞坏死（（n=16）。通过M型及二维超声心动图对左室径线（LVD），短轴缩短率（FS），左室质量（LVM），射血分数（EF）进行了测定。结果：通过对二尖瓣多普勒采用包罗线方法得到如下数据：等容舒张时间（IVR），E峰和A峰速度，充盈分数。与正常人对照无排异的移植受者心率较快，等容舒张时间较长，头1／3面积分数减少。而EF、LVM、E、A峰速度均相同。中度排异与无排异的患者比较，EF和E峰速度均减低了。结论：从轻度到中度排异，各指标无进一步变化。这些指标对于心脏排异反应都不具有特异性。

Echocardiographic Indexes of Allograft Rejection in Pediatric Cardiac Transplant Recipients

Objective:To determine the usefulness of echocardiographic indexes of left ventricular(LV) functions as possible predictors of cardiac rejection.Methods:12 transplant recipients(aged 3 to 17 years) underwent a total of 52 serial echocardiographic examinations and cardiac biopsies.The results were compared to those of 12 normal children(aged 2 to 17 years).Results:From the mitral valve Doppler tracing,the following measurements were made:isovolumic relaxation time,peak E and peak A velocities,and the fraction of filling under the E and A awaves as well as in the first third or diastole.Compared with normal subject,transplant recipients with no rejection had higher heart rates,longer isovolumic relaxation time decreased first third area fraction and similar shortening fraction.LV mass,and peak E and A velocities.Compared with transplant recipients with rejecttion,patients in whom wild rejection developed also had decreased shortening fraction and decreased peak E velocity.Conclusion:From mild to moderate rejecion,no further changes are noted in any echocardiographic indexes measured.However,none of the indexes provides an acceptably sensitive and specific indicator of cardiac rejection in pediatric transplant recipsents.