肥厚型梗阻性心肌病患者发生肺高压的临床研究

发布时间：2018-07-09 22:12

本文选题：肥厚型心肌病 + 肺高压　；参考：《北京协和医学院》2017年博士论文

【摘要】：目的:探讨肥厚型梗阻性心肌病(hypertrophic cardiomyopathy,HCM)患者发生肺高压(pulmonary hypertension,PH)的易患因素。方法:入选356例于中国医学科学院阜外医院住院的肥厚型梗阻性心肌病患者作为研究对象,统计其肺高压的比例及临床分布情况;将研究对象分为2组(对照组和肺高压组),比较其临床特点,并采用logistic回归分析研究肥厚型梗阻性心肌病患者发生肺高压的危险因素。结果:多因素logistic回归分析发现:女性(OR=2.70,95%CI1.32～5.54,P0.01)、左室流出道/中部压差大(OR=1.02,95%CI1.01～1.03,P0.01)、房颤病史(OR=2.81,95%CI 1.13～6.98,P=0.03)和二尖瓣中重度返流史(OR=5.16,95%CI 2.53～10.54,P0.01)是肺高压的独立危险因素。根据性别分层后显示,只有二尖瓣中重度返流(OR=9.69,95%CI3.03～30.93,P0.01)是男性患者肺高压的独立危险因素,而房颤(OR=4.31,95%CI1.2～15.51,P=0.03)、二尖瓣中重度返流(OR=3.06,95%CI 1.19～7.88,P=0.02)、左室流出道/中部压差大(OR=1.02,95%CI1.01～1.04,P0.01)、左房内径大(OR=1.09,95%CI1.01～1.17,P=0.03)是女性患者肺高压的独立危险因素。轻度肺高压和中重度肺高压两组间危险因素差异无统计学意义。结论:女性、左室流出道/中部压差大、房颤病史和二尖瓣中重度返流史是肥厚型梗阻性心肌病患者发生肺高压的易患因素。背景和目的:左心疾病例如射血分数保留的心衰、二尖瓣疾病,同样还有肥厚型心肌病可能引起左房充盈压升高,继而引起肺高压。不过,既往没有研究描述中国人群中合并肺高压的肥厚型梗阻性心肌病患者的情况。本研究旨在探究肥厚型梗阻性心肌病患者人群中的肺高压的发生比例,合并肺高压的临床特征,以及合并肺高压的肥厚型梗阻性心肌病患者行心肌切除术的临床预后。方法:本研究纳入2011年3月至2016年3月于中国医学科学院阜外医院行室间隔心肌切除手术的325名肥厚型梗阻性心肌病患者。在术前采用超声心动图评估患者的肺动脉收缩压,肺动脉收缩压≥35mmHg时定义为肺高压。结果:肥厚型梗阻性心肌病患者中肺高压的比例为13.8%(45例),肺动脉收缩压的中位数为43mmHg。与没有肺高压的患者相比,合并肺高压的患者女性比例较高,年龄偏大,心房颤动史比例更高,纽约心脏病学会心功能分级更高,左室流出道或左室中部压差更大,并且左房内径更大。经过中位数为20.5月的随访时间,超声心动图结果提示肺高压患者的肺动脉收缩压下降为30mmHg。9/13中重度肺高压患者和27/32轻度肺高压患者的肺血管压力转为正常,仍有5/32轻度肺高压患者的PASP≥35mmHg。另一方面,进行室间隔心肌切除手术后,合并肺高压患者与没有肺高压患者的全因死亡及心血管相关住院事件没有统计学差异。结论:室间隔心肌切除手术可以减轻合并肺高压的肥厚型梗阻性心肌病患者的肺血管压力;进行室间隔心肌切除手术后,合并肺高压患者的全因死亡及心血管住院复合终点事件相同。背景和目的:肥厚型梗阻性心肌病患者发生心力衰竭和心血管死亡的风险是增加的,心肌切除手术能够减轻症状,改善心功能。本研究旨在探究肥厚型梗阻性心肌病患者血浆中基质裂解素-2(ST2)和半乳糖凝集素-3(Gal-3)水平变化,以及这两个标志物与肥厚型梗阻性心肌患者心肌切除术后临床预后的关系。方法:本研究纳入2011年至2016年于中国医学科学院阜外医院行室间隔心肌切除手术的肥厚型梗阻性心肌病患者。我们采用Cox风险回归模型来研究全因死亡及心血管住院复合终点事件的预测因子。结果:酶联免疫吸附法结果提示肥厚型梗阻性心肌病患者的可溶性ST2与Gal-3浓度是明显升高的(P均0.001)。低ST2浓度组与高浓度ST2浓度组的全因死亡和心血管住院的复合终点事件发生率没有明显差异(13%vs.9%;P=0.58)。同样的,两组不同Gal-3浓度组之间的全因死亡和心血管住院的复合终点事件发生率也没有统计学差异(7%vs.15%;log-rank P = 0.25)。Cox回归分析显示可溶性ST2和Gal-3均不能预测患者行心肌切除术后全因死亡及心血管住院复合终点事件(P均0.05)。高龄(校正 HR,1.06;95%CI:1.02-1.11,P0.01)和男性(校正 HR,2.92;95%CI:1.02-8.36,P0.05)是室间隔心肌切除术后全因死亡及心血管住院复合终点事件的独立预测因子结论:在肥厚型梗阻性心肌病患者中,血浆可溶性ST2和Gal-3浓度是升高的。不过,可溶性ST2和Gal-3与患者心肌切除术后的的临床事件没有关联。另一方面,高龄和男性是室间隔心肌切除术后全因死亡及心血管住院复合终点事件的独立预测因子。
[Abstract]:Objective: To investigate the susceptibility factors of hypertrophic cardiomyopathy (HCM) in patients with hypertrophic obstructive cardiomyopathy (pulmonary hypertension, PH). Methods: 356 patients with hypertrophic obstructive cardiomyopathy hospitalized in Fuwai Hospital of Chinese Academy of Medical Sciences were selected as the subjects. The proportion of the pulmonary hypertension and the clinical distribution of the patients were investigated. The subjects were divided into 2 groups (control group and pulmonary hypertension group), compared their clinical characteristics, and using logistic regression analysis to study the risk factors of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy. Results: multiple factor Logistic regression analysis found that women (OR=2.70,95% CI1.32 ~ 5.54, P0.01), left ventricular outflow tract / central pressure difference (OR=1.02, 95%CI1.01 ~ 1.03, P0.01), the history of atrial fibrillation (OR=2.81,95%CI 1.13 ~ 6.98, P=0.03) and mitral valve moderate and severe reflux (OR=5.16,95%CI 2.53 ~ 10.54, P0.01) were independent risk factors for pulmonary hypertension. According to sex stratification, only mitral regurgitation (OR= 9.69,95%CI3.03 ~ 30.93, P0.01) was an independent risk of pulmonary hypertension in male patients. Factors, atrial fibrillation (OR=4.31,95%CI1.2 ~ 15.51, P=0.03), mitral valve moderate and severe reflux (OR=3.06,95%CI 1.19 ~ 7.88, P=0.02), left ventricular outflow tract / central pressure difference (OR=1.02,95%CI1.01 to 1.04, P0.01), left atrial diameter (OR=1.09,95%CI1.01 to 1.17, P=0.03) were independent risk factors for pulmonary hypertension in female patients. Mild pulmonary hypertension and moderate to severe lung disease. There was no significant difference in the risk factors among the two groups. Conclusion: women, left ventricular outflow tract / central pressure difference, atrial fibrillation history and mitral regurgitation history are the risk factors for hyperbaric hypertension in patients with hypertrophic obstructive cardiomyopathy. Background and objective: left heart disease, such as heart failure, mitral valve disease with retained blood score, and mitral valve disease Hypertrophic cardiomyopathy may cause elevated left atrial filling pressure and subsequent pulmonary hypertension. However, there is no previous study to describe the situation of hypertrophic obstructive cardiomyopathy in Chinese people with pulmonary hypertension. The purpose of this study was to explore the incidence of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy, and the clinical specificity of combined pulmonary hypertension. Clinical prognosis of patients with hypertrophic obstructive cardiomyopathy with hyperbaric obstructive cardiomyopathy combined with pulmonary hypertension. Methods: 325 patients with hypertrophic obstructive cardiomyopathy from March 2011 to March 2016 in Fuwai Hospital of the Chinese Academy of Medical Sciences were enrolled. Echocardiography was used to evaluate the patients' lungs before operation. Systolic pressure and pulmonary systolic pressure were defined as pulmonary hypertension. Results: the proportion of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy was 13.8% (45 cases), and the median of systolic pressure of pulmonary artery was 43mmHg. compared with those with no pulmonary hypertension. The proportion of women with pulmonary hypertension was higher, age was larger, and the history of atrial fibrillation was higher. The heart function of the New York Institute of Cardiology is higher, the left ventricular outflow tract or the central left ventricle is greater, and the left atrium is larger. After a median follow-up of 20.5 months, the echocardiographic results suggest that the systolic pressure of the pulmonary artery in the patients with pulmonary hypertension is reduced to the pulmonary blood of 30mmHg.9/13 patients with moderate to severe pulmonary hypertension and 27/32 patients with mild pulmonary hypertension. The pressure of the tube turned to normal, and there was still PASP more than 35mmHg. in patients with 5/32 mild pulmonary hypertension. After ventricular septal resection, there was no significant difference in all cause deaths and cardiovascular related hospitalization events in patients with pulmonary hypertension and no pulmonary hypertension. Conclusion: ventricular septum resection can reduce the fertilizer combined with pulmonary hypertension. Pulmonary vascular pressure in patients with thick obstructive cardiomyopathy; all causes of death and cardiovascular hospitalization in patients with pulmonary hypertension after ventricular septal resection are the same. Background and objective: the risk of heart failure and cardiovascular death in patients with hypertrophic obstructive cardiomyopathy is increased, and cardiac excision can be reduced. The aim of this study was to explore the changes in plasma levels of matrix lysin -2 (ST2) and galactose -3 (Gal-3) in patients with hypertrophic obstructive cardiomyopathy, and the relationship between the two markers and the clinical prognosis of hypertrophic obstructive myocardium after cardiac excision. Methods: This study was included in China from 2011 to 2016. The Cox risk regression model was used to study the predictors of complex endpoint events in all causes of death and cardiovascular hospitalization by the Cox risk regression model. Results: the results of enzyme linked immunosorbent assay showed the soluble ST2 and Gal-3 concentration in patients with hypertrophic myocardial infarction. The degree was significantly higher (P 0.001). There was no significant difference in the incidence of the combined end events of all cause deaths and cardiovascular hospitalization in the low ST2 concentration group and the high concentration ST2 concentration group (13%vs.9%; P=0.58). Similarly, there was no statistical difference between the total cause of death of the two groups and the incidence of complex endpoints in the cardiovascular and cardiovascular hospital between groups of different Gal-3 concentrations. Different (7%vs.15%; log-rank P = 0.25).Cox regression analysis showed that both soluble ST2 and Gal-3 did not predict the total cause of death and cardiovascular hospitalization after cardiac excision (P all 0.05). Age (corrected HR, 1.06; 95%CI:1.02-1.11, P0.01) and men (correction HR, 2.92; 95%CI:1.02-8.36,) were all after ventricular septal excision. Independent predictors of the compound endpoint of death and cardiovascular hospitalization: plasma soluble ST2 and Gal-3 concentrations were elevated in patients with hypertrophic obstructive cardiomyopathy. However, soluble ST2 and Gal-3 were not associated with clinical events after cardiac excision. On the other hand, elderly and male were interventricular septal excision Independent predictors of post all-cause death and cardiovascular end-point composite events.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R542.2;R544.1

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