Mao Shan-shan, Zhao Zheng-yan, Jiang Guo-ping
Neonatal Screering Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhonghua Er Ke Za Zhi. 2004 Jul;42(7):507-10.
To evaluate left ventricular function in neonates with congenital hypothyroidism (CH) and its correlation with thyroid hormones serum levels.
M-mode echocardiography [left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS)], pulse wave Doppler [the peak early diastolic mitral inflow velocity (Em), the peak late diastolic mitral inflow velocity (Am)], quantitative tissue velocity imaging (QTVI) [the systolic peak mitral annular velocity (sm), the early diastolic peak mitral annular velocity (em), the late diastolic peak mitral annular velocity (am)] and tissue tracking imaging (TTI) [the systolic mitral annular displacement (MAD)] were evaluated in 35 neonates with congenital hypothyroidism aged 15-28 days and 30 normal neonates in this study. Correlation analysis was also made between left ventricular function and serum TT3, TT4 and TSH levels.
Left systolic function parameters (LVEF, LVFS, sm and MAD) were 0.62 +/- 0.08, (28.21 +/- 5.31)%, (2.58 +/- 0.59) cm/s and (0.27 +/- 0.07) cm, respectively, in CH group, and 0.67 +/- 0.06, (31.16 +/- 4.13)%, (3.24 +/- 0.52) cm/s and (0.41 +/- 0.08) cm in control group (P < 0.05, P < 0.01). Left diastolic function parameters (Am, Em/Am, em/am, Em and em) were (0.59 +/- 0.10) m/s, 0.98 +/- 0.18, 0.82 +/- 0.40, (0.57 +/- 0.11) m/s and (2.83 +/- 1.48) cm/s, respectively, in CH group, and (0.65 +/- 0.10) m/s, 1.14 +/- 0.20, 1.25 +/- 0.33, (0.73 +/- 0.11) m/s and (4.46 +/- 1.29) cm/s in control group (P < 0.05, P < 0.01). MAD, sm, Em and em in CH group were greatly lower than that in control group (P < 0.001). Left systolic function (LVEF, sm, MAD) and diastolic function (Em, Am, em, em/am) were positively correlated with TT3, TT4 serum levels (P < 0.05, P < 0.01), and negatively with TT4 serum levels (P < 0.05, P < 0.01). MAD, Em and em were highly correlated with TT4, TSH serum levels (r = 0.700, r = 0.564, r = 0.593, r = 0.564, P < 0.001; r = -0.674, r = -0.521, r = -0.578, r = -0.632, P < 0.001).
Neonates with CH have lower left systolic and diastolic function. Left ventricular function was affected by thyroid hormones. QTVI and TTI are more sensitive parameters in evaluating left ventricular function of neonates with congenital hypothyroidism than conventional echocardiography.
评估先天性甲状腺功能减退症（CH）新生儿的左心室功能及其与血清甲状腺激素水平的相关性。
本研究对35例年龄在15 - 28天的先天性甲状腺功能减退症新生儿和30例正常新生儿进行了M型超声心动图检查[左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）]、脉冲波多普勒检查[二尖瓣舒张早期血流峰值速度（Em）、二尖瓣舒张晚期血流峰值速度（Am）]、定量组织速度成像（QTVI）[二尖瓣环收缩期峰值速度（sm）、二尖瓣环舒张早期峰值速度（em）、二尖瓣环舒张晚期峰值速度（am）]以及组织追踪成像（TTI）[二尖瓣环收缩期位移（MAD）]。同时还对左心室功能与血清TT3、TT4和TSH水平进行了相关性分析。
CH组的左心室收缩功能参数（LVEF、LVFS、sm和MAD）分别为0.62±0.08、（28.21±5.31）%、（2.58±0.59）cm/s和（0.27±0.07）cm，对照组分别为0.67±0.06、（31.16±4.13）%、（3.24±0.52）cm/s和（0.41±0.08）cm（P<0.05，P<0.01）。CH组的左心室舒张功能参数（Am、Em/Am、em/am、Em和em）分别为（0.59±0.10）m/s、0.98±0.18、0.82±0.40、（0.57±0.11）m/s和（2.83±1.48）cm/s，对照组分别为（0.65±0.10）m/s、1.14±0.20、1.25±0.33、（0.73±0.11）m/s和（4.46±1.29）cm/s（P<0.05，P<0.01）。CH组的MAD、sm、Em和em显著低于对照组（P<0.001）。左心室收缩功能（LVEF、sm、MAD）和舒张功能（Em、Am、em、em/am）与血清TT3、TT4水平呈正相关（P<0.05，P<0.01），与血清TSH水平呈负相关（P<0.05，P<0.01）。MAD、Em和em与血清TT4、TSH水平高度相关（r = 0.700，r = 0.564，r = 0.593，r = 0.564，P<0.001；r = -0.674，r = -0.521，r = -0.578，r = -0.632，P<0.001）。
CH新生儿的左心室收缩和舒张功能较低。左心室功能受甲状腺激素影响。与传统超声心动图相比，QTVI和TTI在评估先天性甲状腺功能减退症新生儿左心室功能方面是更敏感的参数。
