本文選題：肥厚型心肌病 + 肺高壓��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文

【摘要】：目的:探討肥厚型梗阻性心肌病(hypertrophic cardiomyopathy,HCM)患者發(fā)生肺高壓(pulmonary hypertension,PH)的易患因素。方法:入選356例于中國(guó)醫(yī)學(xué)科學(xué)院阜外醫(yī)院住院的肥厚型梗阻性心肌病患者作為研究對(duì)象,統(tǒng)計(jì)其肺高壓的比例及臨床分布情況;將研究對(duì)象分為2組(對(duì)照組和肺高壓組),比較其臨床特點(diǎn),并采用logistic回歸分析研究肥厚型梗阻性心肌病患者發(fā)生肺高壓的危險(xiǎn)因素。結(jié)果:多因素logistic回歸分析發(fā)現(xiàn):女性(OR=2.70,95%CI1.32～5.54,P0.01)、左室流出道/中部壓差大(OR=1.02,95%CI1.01～1.03,P0.01)、房顫病史(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)是肺高壓的獨(dú)立危險(xiǎn)因素。根據(jù)性別分層后顯示,只有二尖瓣中重度返流(OR=9.69,95%CI3.03～30.93,P0.01)是男性患者肺高壓的獨(dú)立危險(xiǎn)因素,而房顫(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/中部壓差大(OR=1.02,95%CI1.01～1.04,P0.01)、左房?jī)?nèi)徑大(OR=1.09,95%CI1.01～1.17,P=0.03)是女性患者肺高壓的獨(dú)立危險(xiǎn)因素。輕度肺高壓和中重度肺高壓兩組間危險(xiǎn)因素差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:女性、左室流出道/中部壓差大、房顫病史和二尖瓣中重度返流史是肥厚型梗阻性心肌病患者發(fā)生肺高壓的易患因素。背景和目的:左心疾病例如射血分?jǐn)?shù)保留的心衰、二尖瓣疾病,同樣還有肥厚型心肌病可能引起左房充盈壓升高,繼而引起肺高壓。不過(guò),既往沒(méi)有研究描述中國(guó)人群中合并肺高壓的肥厚型梗阻性心肌病患者的情況。本研究旨在探究肥厚型梗阻性心肌病患者人群中的肺高壓的發(fā)生比例,合并肺高壓的臨床特征,以及合并肺高壓的肥厚型梗阻性心肌病患者行心肌切除術(shù)的臨床預(yù)后。方法:本研究納入2011年3月至2016年3月于中國(guó)醫(yī)學(xué)科學(xué)院阜外醫(yī)院行室間隔心肌切除手術(shù)的325名肥厚型梗阻性心肌病患者。在術(shù)前采用超聲心動(dòng)圖評(píng)估患者的肺動(dòng)脈收縮壓,肺動(dòng)脈收縮壓≥35mmHg時(shí)定義為肺高壓。結(jié)果:肥厚型梗阻性心肌病患者中肺高壓的比例為13.8%(45例),肺動(dòng)脈收縮壓的中位數(shù)為43mmHg。與沒(méi)有肺高壓的患者相比,合并肺高壓的患者女性比例較高,年齡偏大,心房顫動(dòng)史比例更高,紐約心臟病學(xué)會(huì)心功能分級(jí)更高,左室流出道或左室中部壓差更大,并且左房?jī)?nèi)徑更大。經(jīng)過(guò)中位數(shù)為20.5月的隨訪時(shí)間,超聲心動(dòng)圖結(jié)果提示肺高壓患者的肺動(dòng)脈收縮壓下降為30mmHg。9/13中重度肺高壓患者和27/32輕度肺高壓患者的肺血管壓力轉(zhuǎn)為正常,仍有5/32輕度肺高壓患者的PASP≥35mmHg。另一方面,進(jìn)行室間隔心肌切除手術(shù)后,合并肺高壓患者與沒(méi)有肺高壓患者的全因死亡及心血管相關(guān)住院事件沒(méi)有統(tǒng)計(jì)學(xué)差異。結(jié)論:室間隔心肌切除手術(shù)可以減輕合并肺高壓的肥厚型梗阻性心肌病患者的肺血管壓力;進(jìn)行室間隔心肌切除手術(shù)后,合并肺高壓患者的全因死亡及心血管住院復(fù)合終點(diǎn)事件相同。背景和目的:肥厚型梗阻性心肌病患者發(fā)生心力衰竭和心血管死亡的風(fēng)險(xiǎn)是增加的,心肌切除手術(shù)能夠減輕癥狀,改善心功能。本研究旨在探究肥厚型梗阻性心肌病患者血漿中基質(zhì)裂解素-2(ST2)和半乳糖凝集素-3(Gal-3)水平變化,以及這兩個(gè)標(biāo)志物與肥厚型梗阻性心肌患者心肌切除術(shù)后臨床預(yù)后的關(guān)系。方法:本研究納入2011年至2016年于中國(guó)醫(yī)學(xué)科學(xué)院阜外醫(yī)院行室間隔心肌切除手術(shù)的肥厚型梗阻性心肌病患者。我們采用Cox風(fēng)險(xiǎn)回歸模型來(lái)研究全因死亡及心血管住院復(fù)合終點(diǎn)事件的預(yù)測(cè)因子。結(jié)果:酶聯(lián)免疫吸附法結(jié)果提示肥厚型梗阻性心肌病患者的可溶性ST2與Gal-3濃度是明顯升高的(P均0.001)。低ST2濃度組與高濃度ST2濃度組的全因死亡和心血管住院的復(fù)合終點(diǎn)事件發(fā)生率沒(méi)有明顯差異(13%vs.9%;P=0.58)。同樣的,兩組不同Gal-3濃度組之間的全因死亡和心血管住院的復(fù)合終點(diǎn)事件發(fā)生率也沒(méi)有統(tǒng)計(jì)學(xué)差異(7%vs.15%;log-rank P = 0.25)。Cox回歸分析顯示可溶性ST2和Gal-3均不能預(yù)測(cè)患者行心肌切除術(shù)后全因死亡及心血管住院復(fù)合終點(diǎn)事件(P均0.05)。高齡(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)是室間隔心肌切除術(shù)后全因死亡及心血管住院復(fù)合終點(diǎn)事件的獨(dú)立預(yù)測(cè)因子結(jié)論:在肥厚型梗阻性心肌病患者中,血漿可溶性ST2和Gal-3濃度是升高的。不過(guò),可溶性ST2和Gal-3與患者心肌切除術(shù)后的的臨床事件沒(méi)有關(guān)聯(lián)。另一方面,高齡和男性是室間隔心肌切除術(shù)后全因死亡及心血管住院復(fù)合終點(diǎn)事件的獨(dú)立預(yù)測(cè)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.
【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
【分類號(hào)】：R542.2;R544.1

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