CAJ | 학술논문

目的比较中国平原地区和高原地区健康儿童心脏形态、功能以及肺动脉压力,并进一步对高原地区的汉族儿童和藏族儿童心脏及肺动脉的指标进行比较.方法入选出生后15 d至14岁的健康儿童,共477名.其中平原地区220名(上海市,海拔16 m),高原地区257名(青海省久治县,海拔3700m).再分别将平原地区和高原地区的儿童按年龄段各分成7组,即≤1个月组、1个月＜且≤6个月组、6个月＜且≤1岁组、1岁＜且≤3岁组、3岁＜且≤6岁组、6岁＜且≤10岁组和10岁＜且≤14岁组.并进一步将高原地区的儿童分为汉族儿童和藏族儿童.采用超声心动图测量儿童左心和右心的形态、收缩功能和舒张功能,通过肺动脉收缩时间估算平均肺动脉压.使用多元线性回归法分析与海拔和年龄相关指标的差异.结果与平原地区比较,在出生后14年内,高原地区儿童的平均肺动脉压较高(P＜0.000 1),右心室舒张期内径随着年龄的增长较快(P=0.000 8),右心室前壁较厚(P=0.05),但左心室大小二者间差异无统计学意义.高原地区健康儿童左、右心室的收缩和舒张功能均明显较低(P＜0.05),但心输出量较大(P ＜0.000 1).高原地区汉族与藏族儿童之间右心室舒张期内径,右心室前壁厚度,左、右心室的收缩和舒张功能,肺动脉压等的差异均无统计学意义(P均＞0.05).结论中国高原地区儿童的平均肺动脉压升高,右心室扩张,出生14年后右心室相对肥厚,左、右心室的收缩和舒张功能降低,而心输出量增高.这些指标在汉族与藏族儿童之间无明显差异.
목적 비교중국평원지구화고원지구건강인동심장형태、공능이급폐동맥압력,병진일보대고원지구적한족인동화장족인동심장급폐동맥적지표진행비교.방법 입선출생후15 d지14세적건강인동,공477명.기중평원지구220명(상해시,해발16 m),고원지구257명(청해성구치현,해발3700m).재분별장평원지구화고원지구적인동안년령단각분성7조,즉≤1개월조、1개월＜차≤6개월조、6개월＜차≤1세조、1세＜차≤3세조、3세＜차≤6세조、6세＜차≤10세조화10세＜차≤14세조.병진일보장고원지구적인동분위한족인동화장족인동.채용초성심동도측량인동좌심화우심적형태、수축공능화서장공능,통과폐동맥수축시간고산평균폐동맥압.사용다원선성회귀법분석여해발화년령상관지표적차이.결과 여평원지구비교,재출생후14년내,고원지구인동적평균폐동맥압교고(P＜0.000 1),우심실서장기내경수착년령적증장교쾌(P=0.000 8),우심실전벽교후(P=0.05),단좌심실대소이자간차이무통계학의의.고원지구건강인동좌、우심실적수축화서장공능균명현교저(P＜0.05),단심수출량교대(P ＜0.000 1).고원지구한족여장족인동지간우심실서장기내경,우심실전벽후도,좌、우심실적수축화서장공능,폐동맥압등적차이균무통계학의의(P균＞0.05).결론 중국고원지구인동적평균폐동맥압승고,우심실확장,출생14년후우심실상대비후,좌、우심실적수축화서장공능강저,이심수출량증고.저사지표재한족여장족인동지간무명현차이.
Objective Chronic hypoxia at high altitude might result in cardiopulmonary adaptations including pulmonary arterial hypertension and cardiac remodeling.But little is known about the adaptive changes in healthy children born and living at high altitude.We compared the echocardiographic measurements between the healthy children living at 16 m (Shanghai,n =220) and 3 700 m (Qinghai,total 257,Han children 117,Tibetan children 140).Methods Children's age ranged from 15 d to 14 years.Echocardiography measurements were performed,values of the left and right ventricular dimensions and wall thickness,systolic and diastolic function including cardiac output index (CI),as well as mean pulmonary arterial pressure (mPAP) were obtained.Results mPAP and right heart dimension,CI,right ventricular anterior wall thickness were significantly higher while ventricular systolic and diastolic function were significantly lower in 3 700 m group than in 16 m group (all P ＜ 0.05).Left ventricular dimension was similar between the two groups.There were no differences on above measured parameters between the Han and Tibetan children from 3 700 m group (all P ＞ 0.05).Conclusions Children born and living at high altitude in China have significantly higher mPAP,dilated right heart and lower systolic and diastolic function of both ventricles and higher CI compared to children born and living at see-level.Above parameters were similar between the Han and the Tibetan childen born and living at high altitude.Present study provides reference values for the healthy children living at high altitude.