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目的通过二维斑点追踪技术获取左室心肌纵向应变,探讨其对儿童川崎病急性期心肌损伤的诊断及预测价值。方法 60例KD急性期患者根据有无冠状动脉扩张(CAE)分为无冠脉损伤组(B组)和冠脉损伤组(C组);选择56例健康体检儿童作为对照组(A组),采集研究对象心肌动态图像,行二维超声心动图检查,记录心尖位左四腔观、二腔观及长轴观图像,使用Simpon法进行左室射血分数(LVEF)测量。应用QLA10.0软件对所采集的心肌图像进行斑点追踪并获得左室二腔心(AP2LS)、三腔心(AP3LS)、四腔心(AP4LS)纵向应变值及左室整体纵向应变值(GLS),分析心肌运动情况。分别计算AP2LS、AP3LS、AP4LS及GLS判断CAE的ROC曲线下面积(AUC),获得鉴别CAE的最佳临界值。结果 (1)常规超声指标LVEF差异无统计学意义。(2)3组间及组间AP2LS、AP3LS、AP4LS及GLS比较差异均有统计学意义(P<0.01)(3)AP2LS、AP3LS、AP4LS、GLS诊断CAE的AUC分别为0.68(95%CI:0.53~0.83),0.86(95%CI:0.74~0.98),0.82(95%CI:0.71~0.93),0.94(95%CI:0.88~1.00)。以AP2LS诊断CAE的AUC为对照,AP3LS、GLS与其比较差异有统计学意义(P<0.05)。ROC曲线显示GLS诊断CAE的敏感度为94%、特异度为90%,AP3LS诊断CAE的敏感度及特异度分别为74%和90%。结论二维斑点追踪成像左室心肌纵向应变技术可早期评估川崎病患儿心肌的受损情况。
Objective To acquire longitudinal strain of left ventricular myocardium by two-dimensional speckle tracking technique, and to investigate the diagnostic and prognostic value of myocardial strain in children with acute Kawasaki disease. Methods Sixty patients with acute KD were divided into two groups according to the presence or absence of coronary artery dilatation (CAE): coronary artery injury group (group B) and coronary artery injury group (group C); 56 healthy children were selected as control group (group A) , Dynamic images were collected from the study subjects. Two-dimensional echocardiography was performed. Left atrium view, two-chamber view and long-axis view were recorded. The left ventricular ejection fraction (LVEF) was measured by Simpon method. The QLA10.0 software was used to track the acquired myocardial images and get the longitudinal strain values of AP2LS, AP3LS, AP4LS and the longitudinal strain of the left ventricle (GLS) ), Analysis of myocardial motion. AP2LS, AP3LS, AP4LS and GLS were calculated respectively to determine the area under the ROC curve (AUC) of CAE, and the best critical value for identifying CAE was obtained. Results (1) There was no significant difference in LVEF of routine ultrasound. (2) There were significant differences in AP2LS, AP3LS, AP4LS and GLS between the three groups and between groups (P <0.01) (3) The AUC of AP2LS, AP3LS, AP4LS and GLS in diagnosing CAE were 0.68 (95% CI: 0.53-0.83), 0.86 (95% CI: 0.74-0.98), 0.82 (95% CI: 0.71-0.93), 0.94 (95% CI: 0.88-1.00). AP2LS diagnosis of CAE AUC as control, AP3LS, GLS and its difference was statistically significant (P <0.05). The ROC curve showed that the sensitivity and specificity of GLS in the diagnosis of CAE were 94% and 90%, respectively. The sensitivity and specificity of AP3LS in diagnosing CAE were 74% and 90% respectively. Conclusion Two-dimensional speckle tracking imaging of left ventricular longitudinal strain can be used to assess myocardial damage in children with Kawasaki disease.