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目的分析川崎病患儿左心室扭转与冠状动脉损害的相关性。方法 852例川崎病患儿(观察组)行冠状动脉造影,跟据是否有冠状动脉损害分为发生组107例和未发生组745例;同期300例正常儿童为对照组。各组均行超声检查,比较冠状动脉损害发生率及左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、左心室收缩末期内径(left ventricular end-systolic dimension,LVESD)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)和左室射血分数(left ventricular ejection fraction,LVEF)。结果 (1)本组冠状动脉损害发生率为12.56%;(2)发生组LVEDD、LVESD、LVEDV、LVESV分别为(59.04±6.82)mm、(42.08±9.05)mm、(176.28±48.51)mL、(88.52±41.09)mL,均高于未发生组((49.16±4.52)mm、(31.29±7.31)mm、(125.09±29.64)mL、(37.69±15.09)mL)及对照组((48.36±3.37)mm、(28.16±4.05)mm、(116.25±26.81)mL、(33.91±11.70)mL),而LVEF((48.91±11.49)%)低于未发生组((65.08±12.19)%)及正常组((70.71±9.52)%)(P<0.05),未发生组以上指标与对照组比较差异无统计学意义(P>0.05);(3)发生组左心室扭转角度、扭转率、旋转角度、心尖旋转率分别为(6.83±2.95)°、(44.19±18.1)°/s、(-4.19±3.08)°、(-48.11±17.53)°/s,均低于未发生组((11.50±3.16)°、(71.53±19.50)°/s、(-6.69±2.54)°、(-53.69±17.50)°/s)及对照组((17.29±6.10)°、(96.08±31.07)°/s、(-8.28±4.01)°、(-71.96±17.07)°/s)(P<0.05),未发生组上述指标与对照组比较差异有统计学意义(P<0.05);(4)左心室扭转角度、扭转率与LVEF呈正相关(r=0.629,P=0.032;r=0.533,P=0.041)与LVEDV(r=-0.763,P=0.013;r=-0.653,P=0.023)、LVESV(r=-0.691,P=0.033;r=-0.763,P=-0.027)均呈负相关。结论川崎病合并左心室扭转时冠状动脉损害发生率高,患者LVEF下降,LVEDV、LVESV则代偿性上升,可致左心室扭转运动减低。
Objective To analyze the correlation between left ventricular torsion and coronary artery lesion in children with Kawasaki disease. Methods 852 children with Kawasaki disease (observation group) underwent coronary angiography. According to the presence or absence of coronary artery lesions, they were divided into the occurrence group (107 cases) and the non-occurrence group (745 cases), and the normal children (300 cases) as the control group. All patients underwent ultrasound examination. The incidences of coronary artery lesions and left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF). Results The incidence of coronary artery lesions in this group was 12.56%. (2) The incidences of LVEDD, LVESD, LVEDV and LVESV were (59.04 ± 6.82) mm, (42.08 ± 9.05) mm, (176.28 ± 48.51) mL, (88.52 ± 41.09) mL, respectively, which were significantly higher than those in the control group (49.16 ± 4.52 mm, 31.29 ± 7.31 mm, 125.09 ± 29.64, 37.69 ± 15.09 mL, and 48.36 ± 3.37 ), (28.16 ± 4.05) mm, (116.25 ± 26.81) mL and (33.91 ± 11.70) mL, respectively, while LVEF was (48.91 ± 11.49)%) Group (70.71 ± 9.52)%) (P <0.05). There was no significant difference between the group without the above indexes and the control group (P> 0.05). (3) The left ventricular torsion angle, torsion rate, rotation angle , And the apex rotation rate were (6.83 ± 2.95) °, (44.19 ± 18.1) ° / s, (-4.19 ± 3.08) ° and (-48.11 ± 17.53 ° ° / s respectively, 3.16) °, (71.53 ± 19.50) ° / s, (-6.69 ± 2.54) °, (-53.69 ± 17.50) ° / s and (17.29 ± 6.10) °, (96.08 ± 31.07) ° / s , (8.28 ± 4.01) ° and (-71.96 ± 17.07) ° / s, respectively (P <0.05). There was a significant difference between the above indexes in the non-occurrence group and the control group (P <0.05) Turn angle, twist rate (R = -0.663, P = 0.023; r = -0.653, P = 0.023), LVESV (r = -0.691, P = P = 0.033; r = -0.763, P = -0.027) were negatively correlated. Conclusions The incidence of coronary artery lesion in patients with Kawasaki disease complicated by left ventricular torsion is high. The LVEF of patients with Kawasaki disease is decreased, LVEDV and LVESV are compensatory, and the left ventricular torsional motion is reduced.