心力衰竭患儿Tei指数与血浆肾上腺髓质素水平的相关性研究.doc

心力衰竭患儿Tei指数与血浆肾上腺髓质素水平的相关性研究 　　作者：丛娟　段桂琴 作者单位：450052　郑州大学第三附属医院超声科(丛娟)，儿内科(段桂琴) 　　【摘要】 目的　探讨心力衰竭(CHF)患儿Tei指数与血浆肾上腺髓质素(ADM)水平的关系，评价ADM在小儿CHF中的临床意义。方法　采集CHF患儿42例和正常对照组23例心尖四腔切面，组织多普勒技术分别测量二尖瓣环后间隔和左心室侧壁位点、三尖瓣环右心室游离壁位点的Tei指数，取3个位点Tei指数的均值作为心脏整体Tei指数。采用放射免疫法测定各组血浆ADM浓度。结果　CHF组Tei指数较对照组延长(P0.05)，治疗后Tei指数较治疗前缩短(P0.01);CHF组血浆ADM水平高于对照组(P0.05)，治疗后血浆ADM水平较治疗前降低(P0.01);CHF组血浆ADM浓度与Tei指数呈现高度相关性，而且与左心室射血分数、短轴缩短率也呈现高度相关性(P0.001)。结论　组织多普勒Tei指数测量便捷、安全，能全面反映CHF患儿的整体心脏功能;血浆ADM水平为临床上评价CHF提供准确信息。ADM水平与Tei指数呈显著相关性。 　　【关键词】 肾上腺髓质素;　心力衰竭;　Tei指数;　儿童 　　【Abstract】　Objective　The purpose of the study was to probe relationship between Tei index and the levels of adrenomedullin (ADM) in children with congestive heart failure (CHF) and to assess the clinical meanings of ADM in children with CHF.Methods　23 normal children and 42 children with CHF were involved. Tei index was defined as (a-b)/b. By tissue Doppler imaging(TDI)， a and b were measured at three different loci at left ventricle apical four-chamber. The mean value of three different loci was calculated. The levels of ADM were measured by specific radioimmunoassay.Results　In CHF group， Tei index was significantly prolonged and the ADM level was significantly higher than those in control subjects (P0.05). After treatment， Tei index was shorted and the levels of ADM were much lower than those before treatment (P0.01). In CHF group， the levels of ADM were correlated with Tei index and were positively correlated with the ejection fraction (EF) and fraction shortening (FS) of left ventricle (P0.001). Conclusions　Tei index by TDI could reflect cardiac global function. The levels of ADM could offer precise information to evaluating CHF in children. 　　【Key words】　Adrenomedullin;　Heart failure;　Tei index;　Child 　　心力衰竭(congestive heart failure，CHF)是小儿急重症之一，过去多强调收缩功能的不足，但心室存在收缩和舒张两期功能，综合评价两者对心功能减退的判断更全面。神经内分泌机制是CHF发生发展的关键问题。研究表明，成人CHF时，血浆肾上腺髓质素(adrenomedullin，ADM)浓度显著升高，可能参与了CHF的发生及发展[1]。本研究旨在探讨Tei指数与CHF患儿血浆ADM水平的关系，评价ADM在小儿CHF中