慢型克山病与缺血性心肌病患者超声心动图检查对比研究

摘要

目的：对慢型克山病（CKD）与缺血性心肌病（ICM）患者超声心动图特点进行对比分析，为临床诊断及鉴别诊断提供依据。方法在山东省克山病病区泗水、邹城、莒县、五莲、沂水和青州6个县（市）选择42例CKD患者作为CKD组；在山东省千佛山医院于住院和门诊诊疗患者中选择31例ICM患者作为ICM组，对观察对象进行超声心动图检查，就心脏形态学、血流动力学和心功能3个方面的改变进行对比研究。结果CKD 组左房内径（LA）、左室舒张末期内径（LVd）、右室内径（RV）、右房横径（RAtd）分别为（45.14±6.93）、（68.48±6.24）、（28.90±3.14）、（52.79±6.62）mm，均大于ICM组[（40.68±5.12）、（60.55±4.07）、（24.35±2.12）、（47.68±8.53）mm，t值分别为3.03、6.55、7.38、2.88，P均<0.01]。 CKD组多房室腔扩大，心脏呈球形，室壁趋向变薄；ICM组以左房室腔扩大为主，左室腔呈“圆拱门形”改变。CKD组的左室射血分数（LVEF）和左室短轴缩短率（LVFS）分别为（40.50±10.68）%、（22.81±6.24）%，均低于ICM组[（54.61±6.58）%、（30.71±4.29）%， t值分别为-6.957、-5.976，P均<0.01]。85.7%（36/42）的CKD患者室壁呈弥漫性运动减低；83.9%（26/31）的ICM患者室壁呈节段性运动异常。 CKD组多瓣膜反流发生率较高且程度较重；ICM组多为单瓣膜反流且程度较轻。结论心腔内径大小、室壁运动异常、瓣膜反流程度及心功能状态等超声心动图特征性改变对CKD与ICM的鉴别具有重要价值。%Objective To investigate the characteristics of chronic Keshan disease (CKD) and ischemic cardiomyopathy ( ICM ) and provide a basis for differential diagnosis . Methods Forty-two cases of CKD were randomly sampled from 6 Keshan disease districts in Sishui, Zoucheng, Juxian, Wulian, Yishui and Qingzhou Counties of Shandong Province, as CKD group. Thirty-one cases of ICM were selected from Qianfushan Hospital as ICM group. Echocardiography was used to analyze the cardiac morphology , hemodynamic and function. Results Left atrial internal diameter(LA), left ventricular(LV), end-diastolic internal diameter(LVd), right ventricular diameter(RV) and right atrial transverse diameter(RAtd) of the CKD group[(45.14 ± 6.93),(68.48 ± 6.24),(28.90 ± 3.14),(52.79 ± 6.62)mm] were higher than those of ICM group[(40.68 ± 5.12),(60.55 ± 4.07),(24.35 ± 2.12), (47.68 ± 8.53)mm , t = 3.03, 6.55, 7.38, 2.88, all P < 0.01]. In CKD group, several atrioventricular carities were enlarged, and the ventricular wall tended to become thin. In ICM group, left atrioventricular cavities were enlarged, and the apex of LV was thin spherical. The LV ejection fraction(LVEF) and fractional shortening of LV (LVFS) of the CKD group [(40.50 ± 10.68)%, (22.81 ± 6.24)%] were lower than those of the ICM group [(54.61 ± 6.58)%, (30.71 ± 4.29)%, t = - 6.957, - 5.976, all P < 0.01]. Diffuse hypokinetic motion of LV reduced in 85.7%(36/42) of CKD patients, and 83.9%(26/31) of ICM patients had segmental LV dyskinesia. Slight regurgitation of single valve was common in ICM group , but several regurgitation of multiple valves were more common in CKD group. Conclusion Echocardiography is a valuable noninvasive technology for differentiating CKD and ICM.