摘要目的：应用三维斑点追踪成像技术（Three-dimensional speckle tracking imaging，3D-STI）探讨初发肾病综合征（Initial onset of nephrotic syndrome，INS）患儿左心室心肌应变的特征，并初步分析在不同24 h尿蛋白总量的患儿中上述指标的变化。方法：收集42例INS患儿（病例组）和30例健康儿童（对照组），对所有受检者进行3D-STI检测，获得三维左心室射血分数（Three-dimensional left ventricular ejection fraction，3D-LVEF）、左心室心肌整体纵向峰值应变（Left ventricular global longitudinal strain，LVGLS）、左心室圆周峰值应变（Left ventricular global circumferential strain，LVGCS）、左心室面积峰值应变（Left ventricular global area strain，LVGAS）、左心室径向峰值应变（Left ventricular global radial strain，LVGRS），采用正态性检验选取合适的统计学方法进行两组间上述参数的比较，并随机抽取病例组中20例INS患儿进行组内及组间的重复性检验，绘制散点图。随后将INS患儿（病例组）按照24 h尿蛋白总量划分为3组，并比较3组内上述参数的差异。结果：①病例组LVEF与对照组比较无明显变化（P>0.05）。3D-STI中病例组与对照组相比较，LVGAS与LVGLS明显减低（P均<0.01），LVGRS和LVGCS无明显变化。②随机抽取病例组中的20例，经Bland-Altman重复性检验后，得出组间LVGAS、LVGCS、LVGLS、LVGRS的平均差值分别为-0.2、-0.13、0.1及0.2，95%置信区间分别为-2.8%~2.3%、-1.65%~1.29%、-2.1%~2.3%及-3.9%~4.3%；组内LVGAS、LVGCS、LVGLS、LVGRS平均差值分别为0.0、-0.36、-0.4及0.1，95%置信区间分别为-2.9%~2.9%、-2.18%~1.45%、-3.2%~2.4%及-4.4%~4.6%。组内及组间INS病例组应变值有良好的可重复性。③对按照24 h尿蛋白量所划分的3组间的参数进行比较，仅有LVGAS与LVGLS在3组间有明显的统计学差异，并且随着24 h尿蛋白总量的增加，上述应变值减低。结论：INS患儿左心室整体应变存在明显异常变化；3D-STI技术对于评价其应变具有良好的可重复性；随着24 h尿蛋白量的增加，患儿的左心室整体应变可能与疾病严重程度相关。
Abstract：Objective: To evaluate the characters of global left ventricular(LV) strain in children with initial onset of nephrotic syndrome(INS) by three-dimensional speckle tracking imaging(3D-STI) technique. And to analysis the differences of the above data between the children with various amount of urine protein in 24 h. Methods: Forty-two INS children were randomly enrolled as INS group, and 30 healthy children were employed as normal controls. Three-dimensional left ventricular ejection fraction(3D-LVEF), global left ventricular longitudinal strain(LVGLS), left ventricular circumferential strain(LVGCS), left ventricular area strain(LVGAS) and left ventricular radial strain(LVGRS) were measured with 3D-STI. All of the data were analyzed by normality test to find out the proper statistical approaches. Then we choose 20 groups randomly to do the repeatability test. Meanwhile, we draw the scatter diagram. At last, we divided the INS group into 3 groups according to their various amount of urine protein in 24 h. Results: ①LVGLS and LVGAS were significant lower in INS group than in normal group(all P<0.05) while LVGCS and LVGRS have no significant differences. ②After the Bland-Altman’s repeatability test, it turned out that the 20 groups which were chosen randomly are in good correspondence with each other not only between-group but also in-group. Compared with between-group, the mean difference value of LVGAS, LVGCS, LVGLS and LVGLS are -0.2, -0.13, 0.1 and 0.2 respectively as well as the confidence interval of them are -2.8%~2.3%, -1.65%~1.29%, -2.1%~2.3% and -3.9%~4.3% respectively. When compared with in-group, the mean difference value of LVGAS, LVGCS, LVGLS and LVGLS are 0.0, -0.36, -0.4 and 0.1 respectively as well as the confidence interval of them are -2.9%~2.9%, -2.18%~1.45%, -3.2%~2.4% and -4.4%~4.6% respectively. ③Compared the data among the 3 INS subgroups, it can be inferred that only LVGAS and LVGLS make the significant differences. With the increasing amount of the urine protein, the data above can go down. Conclusion: The global left ventricular strain in children with INS has significant differences in our study. The new technology used in our study can be well repeated in the same way. The global left ventricular strain may be related to the severity level of the disease.
何 欢，孙菲菲，任卫东，吴 丹. 三维斑点追踪技术评价初发肾病综合征患儿左心室整体应变[J]. 中国临床医学影像杂志, 2016, 27(8): 551-556.
HE Huan, SUN Fei-fei, REN Wei-dong, WU Dan. Three-dimensional speckle tracking imaging in evaluation on global left ventricular strain in children with initial onset of nephrotic syndrome. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(8): 551-556.
[1]Qin Q, Xu R, Dong J, et al. Evaluation of right ventricle function in children with primary nephrotic syndrome[J]. Pediatr Neonatol, 2010, 51(3): 166-171.
[2]中华医学会儿科学分会肾脏病学组. 小儿肾小球疾病的临床分类、诊断及治疗[J]. 中华儿科杂志，2001，39（12）：746-748.
[3]张良，李志辉，银燕，等. 儿童初发IgA肾病肾病综合征型的临床特点[J]. 中国当代儿科杂志，2015，17（8）：786-791.
[4]Cengiz C, Nur C, Selman G, et al. Subclinical cardiovascular disease and its association with risk factors in children with steroid-resistant nephrotic syndrome[J]. Pediatr Nephrol, 2014, 29(1): 95-102.
[5]Ozkan G, Adar A, Ulusoy S, et al. Presence of fragmented QRS and its correlation with myocardial performance index in patients with nephrotic syndrome[J]. Anadolu Kardiyol Derg, 2014, 14(5): 450-455.
[6]韩勇，陈田，夏良华，等. 三维斑点追踪成像技术评价2型糖尿病患者左心室整体应变[J]. 中国医学影像技术，2014，30（5）：755-758.
[7]Galderisi M, Esposito R, Schiano-Lomoriello V, et al. Correlates of global area strain in native hyper-tensive patients: a three-dimensional speckle-tracking echocardiography study[J]. Eur Heart J Cardiovasc Imaging, 2012, 13(9): 730-738.
