Yao Taoyue,Hu Yuan,Chen Wenjuan,et al.Clinical value of right ventricle free wall longitudinal strain plus red blood cell distribution width in pediatric congenital heart disease associated pulmonary arterial hypertension[J].Journal of Clinical Pediatric Surgery,2026,(07):642-646.[doi:10.3760/cma.j.cn101785-202506034]
超声RVFWLS联合RDW在小儿CHD-PAH中的临床价值
- Title:
- Clinical value of right ventricle free wall longitudinal strain plus red blood cell distribution width in pediatric congenital heart disease associated pulmonary arterial hypertension
- 摘要:
- 目的 探讨右室游离壁纵向应变(right ventricular free wall longitudinal strain,RVFWLS)联合红细胞分布宽度(red blood cell distribution width,RDW)在小儿先天性心脏病相关性肺动脉高压(congenital heart disease-related pulmonary arterial hypertension,CHD-PAH)中的临床价值。方法 回顾性分析湖南省儿童医院2020年1月至2024年8月确诊的96例CHD-PAH患儿临床资料,根据随访期间是否发生全因死亡、心肺移植、肺动脉高压(pulmonary arterial hypertension,PAH)病情恶化再入院等主要不良事件,分为不良事件组(31例)和无不良事件组(65例)。比较两组实验室及超声指标差异,通过受试者操作特征(receiver operating characteristic curve,ROC)曲线评估指标预测效能,采用多因素Logistic回归分析发生不良事件独立影响因素。结果 不良事件组RDW、氨基末端脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)、肺动脉收缩压(pulmonary artery systolic pressure,PASP)显著升高(P＜0.05),三尖瓣环外侧壁收缩期位移(tricuspid annular lateral wall systolic displacement,TAPSE)、右室面积变化分数(right ventricular fractional area change,RVFAC)、RVFWLS显著降低(P＜0.05)。多因素Logistic回归分析显示,RDW(OR=1.472,95%CI:1.017~2.021,P=0.017)与RVFWLS(OR=0.678,95%CI:0.515~0.892,P=0.005)是发生不良事件的独立预测因子。ROC曲线分析显示,RVFWLS联合RDW的诊断效能(area under the curve,AUC=0.896)优于单一指标(RVFWLS AUC=0.833、RDW AUC=0.715)。结论 RVFWLS联合RDW可提升小儿CHD-PAH不良事件的预测效能,为临床预后评估提供可靠无创参考。
- Abstract:
- Objective To explore the clinical value of right ventricular free wall longitudinal strain (RVFWLS) plus red blood cell distribution width (RDW) in pediatric congenital heart disease-related pulmonary arterial hypertension (CHD-PAH). Methods This study retrospectively analyzed the clinical data of 96 children diagnosed with CHD-PAH at Hunan Children’s Hospital from January 2020 to August 2024. Based upon whether or not major adverse events such as all-cause death,heart lung transplantation,and pulmonary arterial hypertension (PAH) deterioration occurred during follow-ups,they were assigned into two groups of adverse event (n=31) and no adverse event (n=65).The differences in laboratory and ultrasonic parameters between two groups were compared.The predictive power of significant indicators was evaluated by constructing receiver operating characteristic (ROC) curve.Independent factors influencing adverse events were identified by multiple Logistic regression analysis.Results Adverse event group showed significant elevations in RDW,N-terminal pro brain natriuretic peptide (NT proBNP) and pulmonary artery systolic pressure (PASP) (P<0.05) while tricuspid annular lateral wall systolic displacement (TAPSE),right ventricular fractional area change (RVFAC) and RVFWLS declined significantly (P<0.05).Multivariate regression analysis revealed that RDW (OR=1.472,95%CI:1.017~2.021,P=0.017) and RVFWLS (OR=0.678,95%CI:0.515~0.892,P=0.005) were independent predictors of adverse events.ROC curve analysis revealed that the area under the curve (AUC) of RVFWLS plus RDW (AUC=0.896) was better than that of a single indicator (RVFWLS AUC=0.833,RDW AUC=0.715).Conclusion The combination of RVFWLS and RDW may improve the predictive efficiency of adverse events in pediatric CHD-PAH.It provides reliable non-invasive references for clinical prognostic evaluations.
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备注/Memo
收稿日期:2025-6-15。
基金项目:湖南省卫生健康委员会项目(202109021301)
通讯作者:刘金桥,Email:826423695@qq.com