本文選題：瓣膜 + 鈣化��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文

【摘要】：目的總結(jié)北京醫(yī)院已行尸體解剖老年患者中心臟瓣膜鈣化的檢出率,并分析臨床與病理間的相關(guān)性。方法入選北京醫(yī)院病理科1954年11月7日至2016年3月7日間,年齡60-106歲的老年患者的系統(tǒng)病理解剖資料,共1047例。回顧性分析經(jīng)尸檢病理證實(shí)的心臟瓣膜鈣化的病例,總結(jié)瓣膜鈣化檢出率與年齡、臨床疾病及冠狀動(dòng)脈粥樣硬化間的相關(guān)性。結(jié)果1.1047例尸檢病例中主動(dòng)脈瓣鈣化、二尖瓣鈣化、主動(dòng)脈瓣合并二尖瓣鈣化及心臟瓣膜鈣化檢出率分別為 15.2%(159 例)、9.6%(101 例)、5.4%(57 例)、19.4%(203 例)。2.60-69歲、70-79歲、80-89歲、90-106歲不同年齡組心臟瓣膜鈣化檢出率分別為6.4%(15/234)、12.8%(37/289)、22.5%(70/311)、38.0%(81/213)(趨勢(shì) X2=82.52,P0.01);合并病理冠狀動(dòng)脈狹窄或高血壓、冠心病、糖尿病、慢性腎病的患者心臟瓣膜鈣化檢出率較高。3.多因素回歸分析,不同臨床因素對(duì)發(fā)生瓣膜鈣化的風(fēng)險(xiǎn)分別為年齡(0R=1.066,95%CI:1.048-1.086,P0.01)、高血壓(0R=1.223,95%CI:0.859-1.741,P＞0.05)、冠心病(0R=2.238,95%CI:1.396-3.589,P0.01)、糖尿病(0R=1.053,95%CI:0.700-1.586,P0.05)、慢性腎病(0R=0.924,95%CI:0.610-1.399,P0.05)。4.與無(wú)心臟瓣膜鈣化患者比較,心臟瓣膜鈣化患者發(fā)生冠狀動(dòng)脈粥樣硬化的風(fēng)險(xiǎn)增加(0R=2.983,95%CI:1.868-4.765,P 0.01)。結(jié)論隨增齡,老年人心臟瓣膜鈣化發(fā)生率增加;冠心病患者具有較高的發(fā)生瓣膜鈣化的風(fēng)險(xiǎn);瓣膜鈣化與冠狀動(dòng)脈粥樣硬化相關(guān)。目的評(píng)價(jià)經(jīng)胸超聲心動(dòng)圖(TTE)在老年患者左心瓣膜鈣化診斷中的準(zhǔn)確性。方法回顧性分析,收集1982-2015年在北京醫(yī)院行心臟瓣膜病理檢查的410例老年尸檢患者,患者生前均行經(jīng)TTE檢查;根據(jù)死亡的不同年代分為3組:1982-1995年組、1996-2005年組、2006-2015年組;根據(jù)死亡的不同年齡分為3組:60-75歲組、76-90歲組、91-106歲組。結(jié)果1.以病理檢查結(jié)果為金標(biāo)準(zhǔn),TTE檢查診斷老年左心瓣膜鈣化的敏感性、特異性、診斷符合率、陽(yáng)性似然比、陰性似然比、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為88.6%、28.2%、43.7%、1.234、0.405、0.298、0.878。2.與1982-1995年組比較,1996-2005年組、2006-2015年組隨著時(shí)代發(fā)展,TTE檢查診斷老年左心瓣膜鈣化的敏感性、陽(yáng)性預(yù)測(cè)值逐步增加,特異性、陽(yáng)性似然比、陰性似然比、陰性預(yù)測(cè)值逐步下降。3.與60-75歲組比較,76-90歲組、91-106歲組隨著患者年齡增長(zhǎng),TTE檢查診斷老年左心瓣膜鈣化的敏感性、陽(yáng)性預(yù)測(cè)值逐步增加,特異性、診斷符合率逐步下降。4.以病理檢查作為金標(biāo)準(zhǔn),TTE檢查診斷老年主動(dòng)脈瓣瓣膜與二尖瓣瓣膜鈣化的敏感性、特異性、診斷符合率、陽(yáng)性似然比、陰性似然比、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為 88.2%與 44.0%、30.8%與 75.3%、42.7%與 71.5%、1.275 與 1.780、0.382 與 0.744、0.250 與 0.198、0.909 與 0.906。結(jié)論TTE檢查對(duì)診斷老年左心瓣膜鈣化尤其是主動(dòng)脈瓣瓣膜鈣化敏感性很高,不易漏診,但特異性欠佳。目的研究風(fēng)濕性心臟瓣膜病與非風(fēng)濕性心臟瓣膜病所致心臟瓣膜鈣化的病理特點(diǎn)異同。方法回顧性總結(jié)北京醫(yī)院病理科標(biāo)本庫(kù)中,2002-2016年在心臟外科行瓣膜置換手術(shù)、病理瓣膜鈣化陽(yáng)性的心臟瓣膜標(biāo)本,按照病因分成風(fēng)濕性心臟瓣膜鈣化組、非風(fēng)濕性心臟瓣膜鈣化組,觀察兩組間HE染色光鏡表現(xiàn);從標(biāo)本庫(kù)中選取風(fēng)濕性主動(dòng)脈瓣瓣膜鈣化、風(fēng)濕性二尖瓣瓣膜鈣化與非風(fēng)濕性主動(dòng)脈瓣瓣膜鈣化標(biāo)本各1例行電鏡檢查及能譜分析。結(jié)果1.HE染色可見(jiàn)風(fēng)濕性與非風(fēng)濕性瓣膜鈣化均可有不同程度的瓣膜鈣化,嚴(yán)重者可呈骨樣改變,鈣化呈片狀和點(diǎn)狀分布;風(fēng)濕性瓣膜鈣化標(biāo)本玻璃樣變性較重,厚壁肌性血管多見(jiàn),鈣化一般較重;非風(fēng)濕性瓣膜鈣化標(biāo)本粘液變性較為明顯,厚壁肌性血管少見(jiàn)。2.電鏡可見(jiàn)鈣化物質(zhì)呈點(diǎn)狀和片狀兩種集合體形態(tài),鈣化集中區(qū)域呈片狀分布,周邊呈點(diǎn)狀分布,鈣化顆粒形態(tài)各異,直徑在0.3-5μm;風(fēng)濕性主動(dòng)脈瓣瓣膜鈣化、風(fēng)濕性二尖瓣瓣膜鈣化與非風(fēng)濕性主動(dòng)脈瓣瓣膜鈣化電鏡表現(xiàn)無(wú)明顯差異。3.能譜分析提示不同病因、不同瓣膜鈣化成分基本一樣,主要為C、0、P、Ca元素,并含有Na、Mg;不同病例鈣化部位Ca/P原子百分?jǐn)?shù)比值在1.29-1.48,無(wú)統(tǒng)計(jì)學(xué)差異(p0.05),提示鈣化的物相主要是鈣的磷酸鹽。結(jié)論雖然發(fā)病機(jī)制不同,風(fēng)濕性與非風(fēng)濕性瓣膜鈣化病理表現(xiàn)在HE及電鏡下無(wú)明顯差異,鈣化成分主要是鈣的磷酸鹽。
[Abstract]:Objective to summarize the detection rate of calcification in the center of the elderly patients with autopsy in Beijing Hospital, and to analyze the correlation between clinical and pathological changes. Methods a total of 1047 cases of senile patients aged 60-106 years from November 7, 1954 to March 2016 were selected and 1047 cases were retrospectively analyzed by autopsy pathology. The correlation between valve calcification rate and age, clinical disease and coronary atherosclerosis was confirmed. Results in 1.1047 autopsy cases, aortic valve calcification, mitral calcification, aortic valve calcification with mitral valve calcification, and cardiac valve calcification were 15.2% (159 cases), 9.6% (101 cases), 5.4, 5.4. % (57 cases), 19.4% (203 cases).2.60-69 years, 70-79 years old, 80-89 years old, 90-106 years old heart valve calcification detection rate was 6.4% (15/234), 12.8% (37/289), 22.5% (70/311), 38% (81/213) (trend X2=82.52, P0.01); combined pathological coronary stenosis or hypertension, coronary heart disease, diabetes, chronic kidney disease patients heart valve calcification test .3. multiple regression analysis showed that the risk of valvular calcification in different clinical factors were age (0R=1.066,95%CI:1.048-1.086, P0.01), hypertension (0R=1.223,95%CI:0.859-1.741, P > 0.05), coronary heart disease (0R=2.238,95%CI:1.396-3.589, P0.01), saccharicuria (0R=1.053,95%CI:0.700-1.586, P0.05), chronic kidney disease (0R=0.924,95%CI:0), and chronic kidney disease (0R=0.924,95%CI:0). .610-1.399, P0.05).4. and heart valve calcification in patients with heart valve calcification, the risk of coronary atherosclerosis in patients with heart valve calcification increased (0R=2.983,95%CI:1.868-4.765, P 0.01). Conclusion with age increasing, the incidence of cardiac valve calcification in elderly patients increased; coronary heart disease patients have a higher risk of valve calcification; valve calcification and crown. Objective to evaluate the accuracy of transthoracic echocardiography (TTE) in the diagnosis of left heart valve calcification in elderly patients. Methods a retrospective analysis was made to collect 410 aged autopsy cases in the Beijing Hospital for 1982-2015 years of cardiac valve pathological examination. All the patients were examined by TTE, and 3 groups were divided into 3 groups according to the age of death. 1982-1995 year group, 1996-2005 year group, 2006-2015 year group, 3 groups according to the age of death: 60-75 year old group, 76-90 year old group, 91-106 year old group. Results 1. with pathological examination results as gold standard, TTE examination diagnosis of senile left heart valve calcification sensitivity, specificity, diagnostic coincidence rate, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative The predicted values were 88.6%, 28.2%, 43.7%, 1.234,0.405,0.298,0.878.2. and 1982-1995 year group, 1996-2005 year group, 2006-2015 year group with the age development, TTE examination was used to diagnose the sensibility of senile left heart valve calcification, the positive predictive value increased gradually, the specificity, positive ratio, negative likelihood ratio, negative predictive value gradually decreased.3. and 60-75. The age group, 76-90 year old group, 91-106 year old group, with the age of the patients, the TTE examination was sensitive to the diagnosis of senile left heart valve calcification, the positive predictive value increased gradually, the specificity, the diagnostic coincidence rate gradually decreased with the pathological examination as the gold standard. The TTE examination was used to diagnose the sensitivity and specificity of the senile active valve valve and mitral valve calcification. Diagnostic coincidence rate, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value were 88.2% and 44%, 30.8% and 75.3%, 42.7% and 71.5%, 1.275 and 1.780,0.382 and 0.744,0.250 and 0.198,0.909 and 0.906. TTE examination were very sensitive to the diagnosis of senile left heart valve calcification, especially aortic valve calcification. Objective to study the pathological characteristics of cardiac valve calcification caused by rheumatic valvular heart valvular disease and non rheumatic valvular heart valvular disease. Methods a retrospective summary of the heart valve replacement surgery in the heart surgery department and the valve calcification positive valve specimens in the Beijing Hospital for 2002-2016 years were reviewed. The causes were divided into rheumatic heart valve calcification group, non rheumatic heart valve calcification group, and observed two groups of HE staining light microscopy. 1 cases of rheumatic aortic valve calcification, rheumatic mitral valve calcification and non rheumatic valvular valvular valve calcification were examined by electron microscopy and energy spectrum analysis. The results of 1.HE staining were observed. It can be seen that rheumatic and non rheumatic valvular calcification can have valvular calcification in varying degrees. Serious patients can have bone like changes, calcification is flaky and punctate; rheumatic valvular calcification specimens are heavier, thicker wall myogenic vessels are more common, calcification is generally heavier, non rheumatic valvular calcification specimens have more obvious mucous degeneration and thick wall myosmosis. The rare.2. electron microscope showed that the calcified substance showed two kinds of aggregations in the form of dot and flake. The calcified concentrated area was distributed in a flaky area, the surrounding area was punctually distributed, the calcified particles were different, the diameter was in the 0.3-5 mu m, the rheumatic valvular valve calcification, the rheumatic mitral valve calcification and the non rheumatic valvular valve calcification were not clear. The difference of.3. spectrum analysis suggested that different valvular calcification components were basically the same, mainly C, 0, P, Ca, and Na, Mg; the percentage ratio of Ca/P atom in calcification sites in different cases was not statistically different (P0.05), suggesting that calcified substance was mainly calcium phosphate. Conclusion although the pathogenesis is different, rheumatism and non The pathological findings of rheumatic valvular calcification were not significantly different under HE and electron microscopy. Calcium was the main component of calcification.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R542.5

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