2023 年第 12 期 第 18 卷

超声心动图在大动脉炎患者心脏受累及其程度评估方面的应用价值

The application value of echocardiography in the evaluation of cardiac involvement and its degree in patients with Takayasu arteritis

作者：唐铁骑付佳荣刘金凤张纯

英文作者：Tang Tieqi Fu Jiarong Liu Jinfeng Zhang Chun

单位：首都医科大学附属北京安贞医院介入超声科，北京100029

英文单位：Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：大动脉炎；心脏受累；超声心动图；肺动脉高压

英文关键词：Takayasuarteritis;Cardiacinvolvement;Echocardiography;Pulmonaryhypertension

• 摘要：

• 目的  探讨超声心动图在大动脉炎患者心脏受累及其程度评估方面的应用价值。方法  收集2015年1月至2021年12月在首都医科大学附属北京安贞医院治疗的127例诊断为大动脉炎患者的病历资料行回顾性分析。根据是否有心脏受累，患者被分为心脏受累组（68例）和心脏未受累组（59例），心脏受累组根据患者是否合并肺动脉高压进一步分为肺动脉高压组（11例）和无肺动脉高压组（57例）。比较心脏受累组和心脏未受累组一般资料差异，探讨各组间超声心动图指标的异同。结果  心脏受累组红细胞沉降率明显高于心脏未受累组［16.00(7.00,39.00) mm/1 h比14.50(7.50,16.00) mm/1 h］（Z=-2.238，P=0.025）。心脏受累组左心房内径、室间隔厚度、左心室后壁厚度、左心室舒张末期内径、左心室收缩末期内径、左心室心肌质量、左心室心肌质量指数、主动脉窦部最大内径、近端升主动脉最大内径、主肺动脉内径、二尖瓣舒张早期血流峰值速度均大于心脏未受累组，左心室射血分数低于心脏未受累组，差异均有统计学意义（均P<0.05)；亚组分析结果显示肺动脉高压组和无肺动脉高压组以上指标（肺动脉高压组除主动脉窦部最大内径外、无肺动脉高压组除二尖瓣舒张早期血流峰值速度外）与心脏未受累组比较差异亦均有统计学意义（均P<0.05），趋势与心脏受累组一致。大动脉炎心脏受累患者的主要分类表现为高血压心脏病、冠心病（冠状动脉粥样硬化性心脏病）、心肌异常、瓣膜功能异常和肺动脉高压，心脏受累组68例患者中18例（26.5%）患者表现为心肌异常，55例（80.9%）患者表现为瓣膜功能异常。结论  大动脉炎合并心脏受累很常见。超声心动图可尽早发现并全面评估心脏受累及其程度，在大动脉炎合并心脏受累患者的诊断和治疗随访方面具有很好的临床应用价值。

• Objective To investigate the application value of echocardiography in the evaluation of cardiac involvement and its degree in patients with Takayasu arteritis (TA). Methods The medical records of 127 patients diagnosed with TA who were treated in Beijing Anzhen Hospital, Capital Medical University from January 2015 to December 2021 were collected and retrospectively analyzed. According to the presence or absence of cardiac involvement, patients were divided into cardiac involvement group (68 cases) and non-cardiac involvement group (59 cases). The patients of cardiac involvement group was further divided into pulmonary hypertension group (11 cases) and non-pulmonary hypertension group (57 cases) according to the presence or absence of pulmonary hypertension. The differences in general data between the cardiac involvement group and the non-cardiac involvement group were compared, and the similarities and differences in echocardiographic indicators between the groups were explored. Results  The erythrocyte sedimentation rate in the cardiac involvement group was significantly higher than that in the non-cardiac involvement group［16.00(7.00,39.00)mm/1 h vs 14.50(7.50,16.00)mm/1 h］(Z=-2.238, P=0.025). The left atrial diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular myocardial mass, left ventricular myocardial mass index, maximum diameter of aortic sinus, maximum diameter of proximal ascending aorta, main pulmonary artery diameter, and peak velocity of early mitral valve diastolic blood flow in the cardiac involvement group were all higher than those in the non cardiac involvement group, and the left ventricular ejection fraction was lower than that in the non-cardiac involvement group (all P<0.05); the subgroup analysis showed that, the pulmonary hypertension group and the non-pulmonary hypertension group had statistically significant differences in the above indicators, except for the maximum diameter of aortic sinus in pulmonary hypertension group and the peak velocity of early mitral valve diastolic blood flow in non-pulmonary hypertension group, compared with the non-cardiac involvement group (all P<0.05), and the trend was consistent with that of the cardiac involvement group. The main classification manifestations of patients with cardiac involvement in TA were hypertensive heart disease, coronary atherosclerotic heart disease, myocardial abnormalities, valve dysfunction, and pulmonary hypertension. Among the 68 patients in the cardiac involvement group, 18 patients(26.5%) showed myocardial abnormalities, and 55 patients(80.9%) showed valve dysfunction. Conclusion TA combined with cardiac involvement is common. Echocardiography can detect and comprehensively evaluate cardiac involvement and its degree as soon as possible. It has great clinical application value in the diagnosis, treatment, and follow-up of patients with TA complicated with cardiac involvement.