| Background Keshan disease is an epidemic cardiomyopathy whose cause is unknown. According to the process of the disease and cardiac function Keshan disease is divided into four types:Acute type, subacute, potential type, chronic type. It has been 73 years since Keshan disease was found in Keshan County in Heilongjiang Province in 1937 and was named by the place name. Along with the progress of the cause study and the improvement of some relevant factors, great changes of the disease spectrum of Keshan disease have taken place since the 1980s late. The main types:acute type and subacute type, which mainly infected preschool children in the epidemic year almost disappeared, but now chronic type and potential type which mainly infected the young adult population are the main types. Recently(2007year), national epidemiological survey data showed that Keshan disease had 480,000 cases in our country. Because the patients with potential type would get better or develop into chronic type, so the actual number of the patients with the chronic type will be larger than this data. The main clinical manifestations of chronic Keshan disease(CKD) are congestive heart failure, various types of arrhythmia, the gradeⅡcardiac function or worse, and partial or complete loss of labor. The course of CKD is different in the different persons and the five-year survival rate of this disease is less than 50%, causing a heavy economic burden on family and society. Nowadays, CKD has become the focus of the current prevention of KD. There is no specific diagnostic methods and specific diagnostic indicators in Keshan disease. It is diagnosed needing diagnostic criteria and the exclusion of other diseases with epidemiology. But only using ECG and chest X-ray examination, we can not identify the CKD and other diseases with cardiac dilatation.Since the late 1980s, echocardiography has been used to the diagnosis of Keshan disease. However, it was not universal because ultrasound scanner was not easy to carry. With the development of ultrasound technology and portable instrument, echocardiography was widely used in Keshan disease inspection, and provide important visual evidence for the diagnosis of Keshan disease. However, in the KD endemic area, there is no study using the echocardiography to detect the change in the structure and function of the heart in the CKD disease.Objectives With color Doppler echocardiography, to detect the differences between chronic Keshan disease and healthy people, and to discover the statistically significant indicators of echocardiography in CKD, providing evidences for clinic diagnosis.Subjects and methods The case-control study was adopted. During September to Novermber in 2009, according to the Diagnostic criteria of Keshan disease(GB17021-1997),64 patients of chronic Keshan disease were randomly sampled as patient group from six Keshan disease districts in Shandong Province:Zoucheng, Sishui, Yishui, Wulian, Jvxian, and Pingyi.34 healthy volunteers being checked up by Shandong Institute for Endemic Diseases Control and Research were selected in control group. Color Doppler echocardiography were performed in both the patient group and the control group, in addition, the patient group accepted the epidemiological investigation.Results (1) In CKD patients, the detection rate of cardiac function gradeⅡ,ⅢandⅣwere followed as 62.50%(40/64),29.69%(19/64),7.81%(5/64); In the patient group, X-ray showed the ration of mild, moderate and significant expansion of the heart were respectively 26.56%(17/64),34.38%(22/64),35.94%(23/64), and 2 cases were normal; In addition, the detection rate of abnormal ECG was 92.19%(59/64); all patients with varying degrees of congestive heart failure signs and symptoms; (2) In patient group, Left atrial internal diameter(LAd), left ventricular end-diastolic internal diameter(LVDd), left ventricular end-systolic internal diameter(LVDs), right ventricular end-diastolic diameter(RVd), aorta diameter(AO), right atrial transverse diameter(LAtd), right atrial length diameter(LA1d) and left ventricle mass of the patient group were higher than those of the control group (35.38±6.89mm vs 26.70±3.27mm; 61.57±8.61mm vs 45.41±4.93mm;45.39±10.29mm vs 26.91±4.35mm; 17.22±3.79mm vs 13.76±2.27mm; 28.69±2.81mm vs 24.09±2.89mm; 38.00±6.05mm vs 31.50±3.32mm;42.68±8.65mm vs 35.82±3.14mm; 283.22±103g vs 156.03±39.86g) (all P<0.05); (3) The left ventricular ejection fraction and the fractional shortening of the left ventricular in the patient group [(49.25±14.33)%, (26.11±9.17)%]were significantly lower than those in the control group[[(73.88±4.04)%, (42.88±3.62)%, all P<0.05]; (4) Mitral inflow showed E/A value was less than that of the control group(P<0.05). According to Mitral Doppler flow spectrum shape and mitral annulus tissue Doppler velocity spectrum shape, the left diastolic dysfunction was classified. The rate of the left ventricular diastolic dysfunction(LVDD) in the CKD patients group was 53.13%, and only 5.88% was found in control group; (5) Diffuse hypokinetic motion of the left ventricle reduced were found in 95.31% of CKD patients, and 4.69% of CKD patients had segmental left ventricular dyskinesia; (6) 75.00%(48/64) of the patients accompanied with mitral regurgitation, and 40.63% of these cases accompanied with tricuspid regurgitation. Meaningful Mitral or tricuspid regurgitation were not found out in the control group.Conclusions (1) The CKD patients with expansion of the heart and decompensated heart function showed congestive heart failure signs and symptoms. X-ray showed that most of the patients have the significant or moderate expansion of their hearts, and the proportion of abnormal ECG was significantly increased; (2) The CKD patients' diameter of atrio-ventricular increased and LV mass increasedsignificantly; (3) The motion of ventricle asystematicly reduced or partly reduced in the CKD patients; (4) The CKD patients had poor heart function; (5) The detection rate of mitral regurgitation were higher than the rate of of tricuspid regurgitation. |
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