目的:研究青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者心脏结构和功能特点,探讨脊柱侧凸胸弯对心脏结构和功能的影响。方法:收集2008年6月~2011年6月南京大学医学院附属鼓楼医院脊柱外科收治的主弯为胸弯的女性AIS患者资料,排除合并有先天性心脏病的15例患者,共374例纳入研究,年龄10~18岁(14.9±1.8岁)。回顾性分析心脏超声多普勒资料,得到AIS患者的心脏结构及功能指标,包括舒张末期室间隔厚度(interventricular septum thickness in end diastole,IVSTD)、舒张末期左室内径(left ventricular inner diameter in end diastole,LVDD)、收缩末期左室内径(left ventricular inner diameter in end systole,LVIDS)、舒张末期左室后壁厚度(posterior wall of left ventricle in end diastole,LVPWD)、主动脉根径(diameter of aortic root,DAR)、舒张末期左房内径(left atrial dimension,LAD)、射血分数(ejection fraction,EF)、肺动脉直径(diameter of arteria pulmonalis,DAP)、左室舒张早期血流充盈峰值流速(E峰),舒张晚期充盈峰值流速(A峰)、主动脉流速(aortic flow velocity,AV)。根据脊柱侧凸冠状面角不同,分为小Cobb角组(Cobb角≤70°)和大Cobb角组(Cobb角>70°),比较两组心脏结构和功能指标;依据矢状面角不同,分为后凸减小(Cobb角<10°)、正常后凸(Cobb角10°~40°)及后凸增加(Cobb角>40°)3组,比较心脏结构和功能指标,确立对心脏结构和功能产生影响的相关单因素。再通过多重线性回归分析,研究对心脏结构和功能产生影响的独立因素及影响强度大小。结果:所有患者心脏结构和功能指标(LVDD、LVIDS、IVSTD、DAR、LVPWD、LAD、DAP、EF、E、A、E/A及AV)数值均在正常范围。在胸椎冠状面角度≤70°组与>70°组之间的LVDD、LVIDS、AV有显著性差异(P<0.05),IVSTD、DAR、LVPWD、LAD、DAP、EF、E、A、E/A两组之间无统计学差异(P>0.05)。在矢状面角度<10°组与10°~40°组之间的LVDD有显著性差异(P<0.05),在矢状面角度<10°组与>40°组之间的IVSTD、LAD、DAP有显著性差异(P<0.05),在矢状面角度10°~40°组与>40°组之间的EF有显著性差异(P<0.05),3组间LVIDS、DAR、LVPWD、E、A、E/A及AV无统计学差异(P>0.05)。多重线性回归分析显示,冠状面角度是LVDD、LVIDS的独立影响因素(P<0.05),其标准化偏回归系数分别为-0.150、-0.162;年龄是LVDD、LVIDS的独立影响因素(P<0.05),其标准化偏回归系数分别为0.139、0.146;其标准化偏回归系数绝对值冠面角度大于年龄;年龄亦是IVSTD、DAR的独立影响因素(P<0.05),其标准化偏回归系数分别为0.217、0.272。结论:AIS患者的心脏结构和功能指标基本上处于正常范围,但胸弯的冠矢状面畸形仍对AIS患者心脏结构产生影响,冠状面角度越大,左室内径值越小。 Objective: To study the cardiac structure and function of adolescent idiopathic scoliosis (AIS) and to investigate the effect of scoliosis on cardiac structure and function. Methods: Data of AIS patients with benign thoracic vertebrae admitted from Department of Spine Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical College from June 2008 to June 2011 were collected. Fifteen patients with congenital heart disease were excluded from the study, and 374 cases were included Study, aged 10 to 18 years (14.9 ± 1.8 years). Cardiac Doppler data were retrospectively analyzed to obtain the cardiac structure and function of AIS patients, including the interventricular septum thickness in end diastole (IVSTD), the left ventricular inner diameter in diastole , LVDD), left ventricular inner diameter in end systole (LVIDS), posterior wall of left ventricle in end diastole (LVPWD), diameter of aortic root (DAR), left atrial dimension (LAD), ejection fraction (EF), diameter of arteria pulmonalis (DAP), peak flow velocity of early left ventricular diastolic filling (peak E ), Peak diastolic filling velocity (A peak) and aortic flow velocity (AV). According to the different coronal angles of scoliosis, they were divided into small Cobb angle group (Cobb angle≤70 °) and large Cobb angle group (Cobb angle> 70 °). The cardiac structure and function were compared between the two groups. According to the sagittal angle (Cobb angle <10 °), normal kyphosis (Cobb angle 10 ° ~ 40 °) and kyphosis (Cobb angle> 40 °). The cardiac structure and function indexes were compared to establish Single factor related to cardiac structure and function. Then by multiple linear regression analysis to study the impact of heart structure and function of independent factors and the impact of strength. RESULTS: All patients had normal cardiac structural and functional parameters (LVDD, LVIDS, IVSTD, DAR, LVPWD, LAD, DAP, EF, E, A, E / A and AV). There were significant differences in LVDD, LVIDS and AV between the group with or without thoracic vertebra (≤70 °) and the group with> 70 ° (P <0.05). IVSTD, DAR, LVPWD, LAD, DAP, EF, E, A, E / A no significant difference between the two groups (P> 0.05). There were significant differences in LVDD between sagittal angle <10 ° group and 10 ° -40 ° group (P <0.05), IVSTD between sagittal angle <10 ° group and> 40 ° group, LAD , DAP (P <0.05). There was significant difference in EF between 10 ° ~ 40 ° group and> 40 ° group in sagittal plane (P <0.05). LVIDS, DAR, LVPWD , E, A, E / A and AV had no statistical difference (P> 0.05). Multiple linear regression analysis showed that the coronal angle was an independent factor of LVDD and LVIDS (P <0.05), and the standardized partial regression coefficients were -0.150 and -0.162, respectively. Age was an independent factor of LVDD and LVIDS (P <0.05) , And the standardized partial regression coefficients were 0.139 and 0.166 respectively. The standardized partial regression coefficients of the absolute values ​​of the coronal angles were greater than the age. Age was also an independent factor for IVSTD and DAR (P <0.05), and the standardized partial regression coefficients were 0.217, 0.272. Conclusion: The cardiac structure and function indexes of AIS patients are basically in the normal range. However, the coronary sagittal deformities of thoracic curves still affect the cardiac structure of AIS patients. The larger the coronal angle, the smaller the left ventricular internal diameter.