心脏淀粉样变的心脏超声及心电图特点  

Echocardiographic and electrocardiographic features of patients with cardiac amyloidosis

作　　者：舒燕[1] 姜荣建[1] 程标[1] 孔洪[1] 赖金川[1] 王正阳[2] 

机构地区：[1]四川省医学科学院四川省人民医院心内科,四川成都610072 [2]四川省医学科学院四川省人民医院心血管超声科,四川成都610072

出　　处：《心血管康复医学杂志》2013年第1期92-95,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:分析心脏淀粉样变患者的心脏超声及心电图特点,为临床医师早期识别和诊断心脏淀粉样变性提供帮助。方法:2003年7月～2011年10月我院结合临床及病理检查确诊心脏淀粉样变性患者20例,回顾性分析其超声心动图和心电图特点。结果:心脏超声检查所见:20例患者均表现室间隔[(15.67±3.60)mm]及左心室后壁向心性增厚[(15.73±3.54)mm]而左心室容积正常;所有患者均存在舒张功能不全;多数患者有左心房增大(19例,95%),心内膜下心肌有颗粒样反光增强(17例,85%),出现中—大量心包积液(11例,55%)。心电图表现为:20例患者心电图肢体导联的电压均较低,肢体导联低电压和假性梗死Q波的发生率分别为55%和45%。结论:不明原因心力衰竭的患者,如果心脏超声示心室肌肥厚且心室容积正常,伴心内膜下心肌内有颗粒样反光增强,而心电图又表现为肢体导联低电压或非梗死性Q波时,应考虑心脏淀粉样变性的可能性。应进一步行病理活检等检查,以利于早期诊断和治疗。Objective： To analyze echocardiographic and electrocardiographic features of patients with cardiac amy- loidosis （CA）. Methods： Combined with clinical and pathological examinations, a total of 20 CA patients were diag- nosed in our hospital from Jul 2003 to Oct 2011, and their echocardiographic and electrocardiographic features were retrospectively analyzed. Results： All 20 patients showed interventricular septal thickening [（15.67 ± 3.60） mm]and left ventricular posterior wall concentric thickening [ （15.73 ± 3.54） mm], but their left ventricular volume were normal; diastolic dysfunction existed in all patients; 19 cases （95%） possessed left atrial enlargement, 17 cases （85%） showed particle-like reflect light enhancement in subendocardial myocardium, 11 cases （55%） occurred moderate-large hydropericardium by echocardiography . The voltage of all limb leads of electrocardiogram were low in all 20 patients, incidence rates of limb lead low voltage and pseudo-infarction Q waves were 55% and 45% respec- tively. Conclusion.. For patients with unknown heart failure, if echocardiography shows ventricular hypertrophy, normal ventricular volume, particle-like reflect light enhancement in subendocardial myocardium and possess limb lead low voltage or pseudo-infarction Q waves of electrocardiogram, then cardiac amyloidosis should be considered, and patients should further receive pathological biopsy examination etc. in order to early diagnose and treat.

关 键 词：淀粉样变性 心肌 超声心动描记术 心电描记术 

分 类 号：R540.45[医药卫生—心血管疾病]