CAJ | 학술논문

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。
목적：대만형극산병（CKD）여결혈성심기병（ICM）환자초성심동도특점진행대비분석，위림상진단급감별진단제공의거。방법재산동성극산병병구사수、추성、거현、오련、기수화청주6개현（시）선택42례CKD환자작위CKD조；재산동성천불산의원우주원화문진진료환자중선택31례ICM환자작위ICM조，대관찰대상진행초성심동도검사，취심장형태학、혈류동역학화심공능3개방면적개변진행대비연구。결과CKD 조좌방내경（LA）、좌실서장말기내경（LVd）、우실내경（RV）、우방횡경（RAtd）분별위（45.14±6.93）、（68.48±6.24）、（28.90±3.14）、（52.79±6.62）mm，균대우ICM조[（40.68±5.12）、（60.55±4.07）、（24.35±2.12）、（47.68±8.53）mm，t치분별위3.03、6.55、7.38、2.88，P균<0.01]。 CKD조다방실강확대，심장정구형，실벽추향변박；ICM조이좌방실강확대위주，좌실강정“원공문형”개변。CKD조적좌실사혈분수（LVEF）화좌실단축축단솔（LVFS）분별위（40.50±10.68）%、（22.81±6.24）%，균저우ICM조[（54.61±6.58）%、（30.71±4.29）%， t치분별위-6.957、-5.976，P균<0.01]。85.7%（36/42）적CKD환자실벽정미만성운동감저；83.9%（26/31）적ICM환자실벽정절단성운동이상。 CKD조다판막반류발생솔교고차정도교중；ICM조다위단판막반류차정도교경。결론심강내경대소、실벽운동이상、판막반류정도급심공능상태등초성심동도특정성개변대CKD여ICM적감별구유중요개치。
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.