心尖肥厚型心肌病283例临床分析  

Apical hypertrophic cardiomyopathy: clinical features and prognosis

作　　者：罗晓亮[1] 高晓津[1] 祝捷[1] 乔树宾[1] 

机构地区：[1]中国医学科学院北京协和医学院,国家心血管病中心,阜外心血管病医院心血管病研究所心内科,北京市100037

出　　处：《中国分子心脏病学杂志》2013年第4期588-591,共4页Molecular Cardiology of China

摘　　要：目的收集心尖肥厚型心肌病(apical hypertrophic cardiomyopathy,AHCM)患者的临床资料,对心尖肥厚型心肌病患者的临床特点进行总结,并对AHCM患者的预后以及影响预后的因素作出初步的分析。方法收集283例AHCM患者的临床资料,对其发病特点和临床特点进行归纳总结,并进行随访和观察,分析影响AHCM预后的危险因素。结果 AHCM患者最常见的起病症状是胸闷、气短;所有患者的心电图存在不同程度的ST-T改变,部分患者伴有心律失常:33例伴有心房颤动(11.66%),29例有室性期前收缩(10.25%),房性期前收缩/房性心动过速19例(6.71%),室颤1例(0.35%)。对269例AHCM患者进行了随访,从确诊后平均随访时间3.57±2.29年。随访中共有7例患者死亡(2.60%),其中心原性死亡2例,非心原性死亡5例;在存活的患者中,有18例曾经在随访期间因心脏原因(心衰、心律失常需要安装永久起搏器、冠心病需要介入治疗)再住院1-3次不等。合计心脏事件发生率9.30%。采用Cox比例风险回归模型进行单因素及多因素分析发现,确诊年龄(Hazard Ratio=1.055,95%CI1.016-1.095,P=0.005)、左房前后径(Hazard Ratio=1.099,95%CI:1.032-1.170,P=0.003)和左室射血分数(Hazard Ratio=0.919,95%CI0.865-0.975,P=0.005)是预后的独立预测因子。结论 AHCM的临床表现差异性很大,活动后胸闷、气短是最主要的临床症状,心电图多有异常T波倒置及ST段改变,该病预后相对较好。确诊年龄、左房内径(LAd)和左室射血分数(LVEF)是预后的独立预测因子,左室射血分数可能是预后的保护性因素,随着增龄或左房增大,患者预后变差。Objective To analyze the clinical characteristics and prognosis of Chinese patients with apical hypertrophic cardiomyopathy （AHCM）. Methods We retrospectively reviewed 283 patients with AHCM evaluated by echocardiography and/or cardiac magnetic resonance （CMR） from January 2005 to August 2012 and analyzed the clinical manifestations and outcomes of them. Cox regression analysis was used to find the predictors of the cardiac events. Results The common presentation of 283 patients involved short of breath, chest pain, arrhythmias and syncope.Males predominated with a number of 221 （78.09%） in this cohort. Patient＇s age ranged from 22 to 85 （47.15 ±11.04） years. The ECG was abnormal in all cases with ST-T changes. Two hundred and sixty-nine patients were followed up for （3.57±2.29） years, Twenty five patients（9.3%） experienced one or more cardiovascular events. In multivariate COX analysis, Age of diagnosis （Hazard Ratio=1.055, 95 % CI 1.016-1.095, P=0.005）, LAd （Hazard Ratio=1.099, 95 % CI; 1.032-1.170, P=0.003） and LVEF （Hazard Ratio=0.919, 95 % CI 0.865-0.975, P=0.005） are independent prognostic factors of cardiac events. Conclusions The clinical presentations of AHCM varies widely, The prevalence of AHCM is high in Chinese HCM patients, and AHCM patients have a benign clinical course. A better prognosis was associated with increased LVEF, but increased Age of diagnosis and LAd were positively related to a poorer prognosis.

关 键 词：心尖肥厚型心肌病 左房内径 左室射血分数 预后 心律失常 

分 类 号：R542.2[医药卫生—心血管疾病]