超声评价二尖瓣环重构与二尖瓣反流严重程度的相关性临床研究  

Correlation Analysis of between Mitral Annular Remodeling and Severity of Chronic Mitral Regurgitation

作　　者：童晓明[1] 赵强 张秀明[1] 于海风[1] 赵云鹤[1] 

机构地区：[1]淄博市中心医院心内科,山东省淄博市255036 [2]山东省淄博市第八医院内科

出　　处：《中国超声医学杂志》2009年第3期250-253,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨二尖瓣环重构与二尖瓣反流严重程度的相关性。 方法206例二尖瓣反流（MR）患者分为轻度二尖瓣反流（Ⅰ）组，中度（Ⅱ）组和重度（Ⅲ）组，另选取46例无二尖瓣反流的正常人作为对照组。对受检者先行常规超声心动图检查，分别选取标准胸骨旁长轴、心尖四腔心和二腔心切面，于心脏收缩和舒张末期检测二尖瓣瓣环内径、左心房内径、左心室内径，并计算左心室射血分数及体表面积，并采用多普勒技术测定二尖瓣反流速度、反流时间和有效反流口面积计算反流容积。 结果206例二尖瓣反流患者中轻度二尖瓣反流76例、中度67例和重度63例；按照二尖瓣反流发病机制分类130例中度和重度二尖瓣反流患者中73例为冠心病缺血性二尖瓣反流，19例为非缺血性二尖瓣反流，38例为过度瓣叶运动、二尖瓣叶糙枷样运动或脱垂非缺血性二尖瓣反流。随着二尖瓣反流严重程度的增加，在舒张期和收缩期测量的瓣环内径呈对称性扩大趋势，左心室和左心房内径均有相关一致的增大。二尖瓣有效反流口面积、反流面积、射流紧缩宽度、最大反流面积、反流面积与左心房面积比值和反流长度与二尖瓣反流严重程度的相关系数依次为0．78、0．76、0．40、0．73、0．69和0．74（P〈0．01）。 结论不论二尖瓣反流的严重程度和发生机制如何，二尖瓣环重构呈轴对称性扩张。慢性二尖瓣反流的心脏重构不仅限于二尖瓣环的重构，还涉及到左心室和左心房的重构变化。Objective To measure the mitral annular parametes and explore the correlation between mitral annular remodeling and severity of chronic mitral regurgitation（MR）. Methods The study population consisted of 206 patients with chronic MR, the patients were divided randomly into mitral MR（ Ⅰ ）group,moderate MR（ Ⅱ ）group, severe MR（ Ⅲ ）group and 46 normal control（NO）group. The mitral annular diameter,left atrium diameter and left ventricular diameter was measured at ventricular end systole and end diastole in the parasternal long-axis, 4-chamber, and 2-chain her planes by a faculty echocardiographer and calculation left ventricular ejection fraction（EF）and body surface area （BSA）. To determinations the mitral regurgitation Velocity, regurgitation time and effective regurgitant orifice area and calculation regurgitation volume by Doppler technique. Results All the 206 patients with mild MR（76 cases） ,moderate MR（67 cases）and severe MR（63 cases）. Of 130 patients with moderate and severe MR were classified according to MR mechanism： 73 coronary heart disease of ischemic MR, 19 nonischic MR, 38 flail/prolapse nonischic MR. With increasing MR severity,there was a corresponding symmetric increase in annular diameter,left atrium diameter and left ventricular diameter in all systolic and diastolic measurements. To analysis the correlation between MR severity and MR parametes,the positive correlations were found between effective regurgitant orifice area, regurgitant volume, width of vena contracta, maximal regurgitant jet area, regurgitant jet area/left atrial area, regurgitant jet length and MR severity （r=0.78,0.76,0.40,0.73,0.69 and 0. 74,P〈0. 01 respectively）. Conclusions Mitrial annular remodeling is symmetric dilataltion, regardless of degree or mechanism. The cariac remodeling seen in MR is not isolated to the mitral annulus but also involves left ventricular and left atrial remodeling changes.

关 键 词：超声心动描记术 二尖瓣闭锁不全 心脏瓣膜假体植入 

分 类 号：R654.2[医药卫生—外科学] R541.4[医药卫生—临床医学]