青少年特发性脊柱侧凸患者心脏异常的发生率

An incidence study of adolescent idiopathic scoliosis with cardiac abnormality

中文关键词:  青少年特发性脊柱侧凸  超声多普勒  心脏

英文关键词:Adolescent idiopathic scoliosis  Doppler ultrasonography  Cardiac

中文摘要:

  【摘要】 目的：研究青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者心脏异常的发生率，探讨可能影响AIS患者心脏异常发生的相关因素。方法：2008年6月~2011年6月收治AIS患者719例，其中男113例，女606例，年龄10～18岁，平均15.1±2.2岁。术前均行心脏超声多普勒检查，统计AIS患者心脏异常的发生率。将心脏异常患者分为先天性心脏病及其他心脏异常2组，分别按性别（男组与女组）、弯型（胸弯组与腰弯/胸腰弯组）分组比较先天性心脏病发生率；分别按弯型（胸弯组与腰弯/胸腰弯组）、Cobb角（≤70°组与>70°组）及胸椎后凸角（<10°、10°~40°与>40°组）分组比较其他心脏异常的发生率。利用二分类Logistic回归分析探讨AIS患者弯型（胸弯组与腰弯/胸腰弯组）、Cobb角（连续变量）及胸椎后凸角（连续变量）是否为其他心脏异常发生的显著相关因素。结果：AIS患者心脏异常发生率为6.68%（48/719），其中先天性心脏病发生率为4.59%（33/719），包括房间隔缺损2.50%（21/719）、室间隔缺损0.56%（4/719）、动脉导管未闭0.28%(2/719)、永存左上腔静脉0.28%（2/719）、法洛四联症0.14%（1/719）、二尖瓣狭窄0.14%（1/719）、单心房单心室0.14%（1/719）及房间隔膨出瘤0.14%（1/719）；其他心脏异常的发生率为2.09%（15/719）,其中二尖瓣脱垂1.11%（8/719）、肺动脉高压0.97%（7/719）。48例存在心脏异常的AIS患者中，36例在入院前未获知存在心脏异常，其中3例（8.33%）入院后需先行心脏干预手术（2例行房间隔缺损修补术，1例行动脉导管未闭封堵术），二期行脊柱侧凸矫正手术；12例入院前已获知有心脏异常，其中10例为先天性心脏病，均在脊柱侧凸发现前已行心脏干预手术。AIS患者先天性心脏病的发生率，按性别、弯型分组组间比较均无显著性差异（P>0.05）；二尖瓣脱垂、肺动脉高压的发生率，按弯型、Cobb角以及胸椎后凸角分组组间比较均无显著性差异（P>0.05）。二分类Logistic回归分析显示，二尖瓣脱垂及肺动脉高压的发生与弯型、Cobb角及胸椎后凸角无显著相关性（P>0.05）。结论：AIS患者有较高的心脏异常发生率，部分心脏异常可能严重影响脊柱手术安全性，需要在脊柱矫形术前先行心脏干预手术。AIS患者脊柱矫形术前应常规行心脏超声多普勒检查以评估心脏情况。

英文摘要:

  【Abstract】 Objectives: To investigate the incidence of adolescent idiopathic scoliosis(AIS) patients with cardiac abnormalities and find risk factors of scoliosis related to cardiac abnormalities. Methods: From June 2008 to June 2011, the clinical data of 719 AIS patients receiving spinal correction in our center were reviewed in this study. There were 113 males and 606 females with a mean age of 15.1±2.2 years old(ranging from 10 to 18 years). Before surgery, each of them underwent cardiac doppler ultrasonography test. Congenital and the other cardiac abnormalities were calculated. After that, the patients were classified according to the gender(man/woman) and scoliosis type(thorax curvature and lumbar/thoracolumbar curvature) to compare the incidence of congenital cardiac abnormalities. The patients were classified according to the scoliosis type(thorax curvature and lumbar/thoracolumbar curvature), Cobb angle(≤70° and >70°) and thoracic kyphosis(<10°, 10°-40° and >40°) to compare the incidence of the other cardiac abnormalities. The binary classification Logistic regression analysis was performed to identify the correlation of the other cardiac abnormalities with the scoliosis type(thorax curvature and lumbar/thoracolumbar curvature), Cobb angle(continuous variable) and thoracic kyphosis(continuous variable) in patients with adolescent idiopathic scoliosis. Through the binary classification Logistic regression analysis, the correlation of the non-congenital cardiac abnormalities with the scoliosis type(thorax curvature and lumbar/thoracolumbar curvature), Cobb angle(continuous variable) and thoracic kyphosis(continuous variable) was reviewed. Results: The incidence of cardiac abnormalities was 6.68%(48/719) in 719 AIS patients. The incidence of congenital cardiac abnormalities was 4.59%(33/719). The most common congenital cardiac abnormalities in AIS patients were atrial septal defect(2.50%, 21/719), ventricular septal defect(0.56%, 4/719) and patent ductus ateriosus（0.28%, 2/719). The incidence of the other cardiac abnormalities was 2.09%(15/719). The other cardiac abnormalities were mitral valve prolapsed(1.11%, 8/719) and pulmonary hypertension(0.97%, 7/719). In 48 AIS patients with cardiac abnormalities, 36 patients denied such history, 3 of whom were noticed to be associated with sever cardiac abnormalities and underwent heart surgical intervention before the spine surgery. 12 patients had learned with heart abnormalities before admission, 10 of whom were noticed to be associated with sever congenital cardiac abnormalities and underwent heart surgical intervention before the spine surgery. There was no significant difference between the gender and scoliosis type on the incidence of congenital cardiac abnormalities. There was no significant difference among scoliosis type, Cobb angle and thoracic kyphosis on the incidence of the other cardiac abnormalities. There was no significant relationship of the incidence of mitral valve prolapsed and pulmonary hypertension with the scoliosis type, Cobb angle or thoracic kyphosis. Conclusions: Cardiac abnormalities are usually complicated with AIS, some of which have serious effects on the spine surgery. Cardiac intervention is necessary before the spine surgery. Cardiac doppler ultrasonography is an essential preoperative examination for AIS patients.