镰状细胞贫血患者的左心室收缩和舒张功能

Taksande Amar, Vilhekar Krishna, Jain Manish, Ganvir Bharti

Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Wardha.

Indian Heart J. 2005 Nov-Dec;57(6):694-7.

BACKGROUND

Sickle cell anemia is a formidable problem in India, and is more prevalent in Maharashtra. Cardiovascular involvement in this condition has not been well studied. The present study therefore sought to investigate the systolic and diastolic left ventricular function of children with sickle cell anemia.

METHODS AND RESULTS

This prospective controlled study comprised of 25 cases of sickle cell anemia, 25 cases of anemia (hemoglobin <11 gm/dl) with 'AA' types of hemoglobin electrophoresis and 25 non-anemic controls (hemoglobin >11 gm/dl) with normal hemoglobin electrophoresis pattern. M-mode, 2-dimensional and Doppler echcardiographic measurements of patients and controls were performed according to criteria of the American Echocardiography Society. In the study cases, age ranged from 5 years to 15 years with the mean age of 9.91 years. There were 14 males and 11 females in the study cases. Patients with sickle cell anemia had significantly larger left atrial (23.26 +/- 3.6 mm, 22.9 +/- 2.56 mm, 20.72 +/- 2.79 mm; p < 0.05), left ventricular (34.88 +/- 4.53, 33.28 +/- 3.28, 30.72 +/- 3.68: p < 0.05) and aortic root (19 +/- 2.7, 18.91 +/- 2.24, 17.56 +/- 1.44; p < 0.05) dimensions. They also had higher indexed end-diastolic left ventricular volumes (101.84 +/- 22.74 ml/m2 v. 65.05 +/- 10.81 ml/m2; p < 0.001), and higher stroke volume (29.32 +/- 11.32 ml, 27.12 +/- 7.82 ml, 22.4 +/- 6.67 ml; p < 0.05). Left ventricular mass (62.24+/- 18.44 gm, 52.53 +/- 16.23 gm, 50.2 +/- 15.68 gm; p < 0.05) was greater in sickle cell anemia patients than in controls. No statistically significant differences were detected in the Doppler finding of patients with or without anemia. No statistically significant correlation was found between echocardiographic parameters (M-mode and Doppler) and the hemoglobin in the sickle cell patients.

CONCLUSIONS

Echocardiography is a useful non-invasive technique to study the changes in cardiac structure and function. In spite of left ventricular volume load and dilation in sickle cell anemic patients, left ventricular contraction was good and systolic function was normal, and there was no correlation between the echocardiographic findings and hemoglobin level.

背景

镰状细胞贫血在印度是一个严重的问题，在马哈拉施特拉邦更为普遍。这种情况下的心血管受累情况尚未得到充分研究。因此，本研究旨在调查镰状细胞贫血患儿的左心室收缩和舒张功能。

方法与结果

这项前瞻性对照研究包括25例镰状细胞贫血患者、25例血红蛋白<11 gm/dl且血红蛋白电泳为“AA”型的贫血患者以及25例血红蛋白电泳模式正常的非贫血对照者（血红蛋白>11 gm/dl）。根据美国超声心动图学会的标准对患者和对照者进行M型、二维和多普勒超声心动图测量。在研究病例中，年龄范围为5岁至15岁，平均年龄为9.91岁。研究病例中有14名男性和11名女性。镰状细胞贫血患者的左心房（23.26±3.6 mm、22.9±2.56 mm、20.72±2.79 mm；p<0.05）、左心室（34.88±4.53、33.28±3.28、30.72±3.68：p<0.05）和主动脉根部（19±2.7、18.91±2.24、17.56±1.44；p<0.05）尺寸明显更大。他们的左心室舒张末期指数容积也更高（101.84±22.74 ml/m²对65.05±10.81 ml/m²；p<0.001），每搏输出量也更高（29.32±11.32 ml、27.12±7.82 ml、22.4±6.67 ml；p<0.05）。镰状细胞贫血患者的左心室质量（62.24±18.44 gm、52.53±16.23 gm、50.2±15.68 gm；p<0.05）大于对照组。在有或无贫血患者的多普勒检查结果中未检测到统计学上的显著差异。在镰状细胞贫血患者中，超声心动图参数（M型和多普勒）与血红蛋白之间未发现统计学上的显著相关性。