摘要：
目的 对高原与平原地区慢型克山病(CKD)患者超声心动图进行对比分析,探讨高原地区CKD患者超声心动图的特异性表现,为影像学诊断提供参考依据.方法 2014年10月至2016年12月,在西藏自治区收集34例CKD患者[男性18例、女性16例,年龄为(44.5±5.6)岁]作为高原组;在山东省收集45例CKD患者[男性21例、女性24例,年龄为(47.3±6.9)岁]作为平原组.对观察对象进行超声心动图检查,就心脏形态、血流动力学和心功能3个方面进行分析.结果 高原组左房内径(LAD)、左室舒张末期内径(LVEDD)、左室质量(LVM)分别为(39.2±4.8)、(56.5±6.3)mm,(232.4±40.2)g,均低于平原组[(48.3±5.7)、(65.2±7.8)mm,(283.7±38.3)g,t=-7.52、-5.30、-5.74,P均＜0.01];高原组右房横径(RATD)、右室横径(RVTD)及右室侧壁厚度(RVWT)分别为(47.6±8.5)、(50.4±7.3)、(4.8±1.1)mm,均高于平原组[(42.3±7.2)、(42.7±6.8)、(3.3±0.7) mm,t=2.99、4.81、7.36,P均＜0.01].高原组二尖瓣血流舒张早期最大充盈速度(E峰)和二尖瓣环舒张早期峰值速度(Em)低于平原组,E/Em高于平原组(t=-2.64、-2.35、2.07,P均＜0.05);高原组右室面积变化分数(FAC)、三尖瓣收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(S')分别为(24.9±2.8)％、(13.2±1.2)mm、(6.8±1.0)cm/s,均低于平原组[(26.3±3.2)％、(14.5±1.3)mm、(7.5±1.2)cm/s,t=-2.02、-4.53、-2.74,P＜ 0.05或＜0.01];高原组三尖瓣环舒张早期峰值速度(e')低于平原组、三尖瓣血流舒张早期最大充盈速度(e)/e'高于平原组(t=-2.07、2.09,P均＜0.05).高原组肺动脉收缩压(SPAP)为(48.5±12.3)mmHg(1 mmHg=0.133 kPa),高于平原组[(41.6±13.3)mmHg,t=2.34,P＜0.05].结论 高原地区CKD患者超声心动图相较于平原地区CKD患者表现为更明显的右心扩大及右心功能衰竭,同时合并更高的SPAP.%Objective The echocardiography of patients with chronic Keshan disease (CKD) in the plateau and plain areas was compared,to analyze the specific manifestations of echocardiography in patients with high altitude CKD,to provide a reference for imaging diagnosis.Methods From October 2014 to December 2016,34 patients with CKD were selected in the Tibet Autonomous Region [18 males,16 females,aged (44.5 ± 5.6) years old] as plateau group;45 patients with CKD were selected in Shandong Province [21 males,24 females,age (47.3 ± 6.9) years old] as a plain group.Echocardiography was performed on the observed subjects,and cardiac morphology,hemodynamics and cardiac function were analyzed.Results The left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD),and left ventricular mass (LVM) of the plateau group were (39.2 ± 4.8),(56.5 ± 6.3) mm and (232.4 ± 40.2) g,respectively,which were lower than those of the plain group [(48.3 ± 5.7),(65.2 ± 7.8) mm,(283.7 ± 38.3) g,t =-7.52,-5.30,-5.74,P ＜ 0.01].The right atrial transverse diameter (RATD),right ventricular transverse diameter (RVTD) and right ventricular lateral wall thickness (RVWT) of the plateau group were (47.6 ± 8.5),(50.4 ± 7.3) and (4.8 ± 1.1) mm,respectively,which were higher than those of the plain group [(42.3 ± 7.2),(42.7 ± 6.8),(3.3 ± 0.7) mm,t =2.99,4.81,7.36,P ＜ 0.01].The early diastolic filling velocity (E),the early diastolic peak velocity of the mitral annular (Em) of the plateau group were lower than those of the plain group,E/Em of the plateau group was higher than that of the plain group (t =-2.64,-2.35,2.07,P ＜ 0.05).The fractional area change (FAC) of right ventricular,tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S') of the plateau group [(24.9 ± 2.8)％,(13.2 ± 1.2) mm,(6.8 ± 1.0) cm/s] were lower than those of the plain group [(26.3 ± 3.2)％,(14.5 ± 1.3) rmm,(7.5 ± 1.2) cm/s,t =-2.02,-4.53,-2.74,P ＜ 0.05 or ＜ 0.01].The tricuspid annular diastolic velocity (e') of the plateau group was lower than that of the plain group,and tricuspid annular blood flow early diastolic filling velocity maximum (e)/e'was higher than that of the plain group (t =-2.07,2.09,P ＜ 0.05).The systolic pulmonary artery pressure (SPAP) of the plateau group [(48.5 ± 12.3) mmHg,1 mmHg =0.133 kPa] was higher than that of the plain group [(41.6 ± 13.3) mmHg,t =2.34,P ＜ 0.05].Conclusion Compared with CKD patients in plain area,CKD patients in plateau area have showed more obvious right heart enlargement and right ventricular failure,and combined with higher SPAP.
