二尖瓣狭窄下游湍流剪应力与心瓣膜损害的关系  

The Relationship Between Turbulent Shear Stress Downstream of Mitral Stenosis and Valvular Lesion in Human Beings

作　　者：张桂敏[1] 石应康[1] 唐红[2] 张尔永[1] 郭仲三[3] 樊渝波[4] 蒲放[4] 曾智[5] 

机构地区：[1]华西医科大学附属第一医院胸心外科,成都610041 [2]华西医科大学附属第一医院超声心动图室,成都610041 [3]中国科学院成都计算机应用研究所 [4]四川大学生物力学系 [5]华西医科大学附属第一医院心内科,成都610041

出　　处：《中国胸心血管外科临床杂志》2001年第4期217-221,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目 ( 39770 2 0 5

摘　　要：目的　明确二尖瓣狭窄下游湍流剪应力 (turbulent shear stress,TSS)与心瓣膜损害的关系 ,为在细胞水平研究 TSS致心瓣膜内皮损伤提供前期研究。　方法　应用多普勒超声心动图与计算机图像分析技术 ,以 14例正常人为对照 (对照组 ) ,对 1998年 1～ 4月在我院就诊的 47例二尖瓣狭窄患者 (观察组 )心瓣膜病变及其下游 TSS进行 2年的随访动态观测。　结果　观察组随访期间心瓣膜病变与其下游 TSS均呈明显加重趋势 (P<0 .0 5 ) ,且二者显著相关 (r=0 .82 ,0 .86 ) ;此外 ,TSS的大小和分布与心瓣膜不同部位病变的严重程度之间存在一定的空间对应关系。结论　二尖瓣狭窄下游所产生的湍流剪应力是构成患者心瓣膜病变进行性加重不容忽视的重要原因 ,其具体作用机制有待进一步研究加以阐明。Objective To identify the relationship between turbulent shear stress (TSS) downstream of mitral stenosis and valvular lesion so that TSS which may cause lesion of endothelium on heart valve can be further studied. Methods Using fourteen normal persons as control (control group), by Doppler echocardiography and image analysis of computer, we observed TSS downstream of mitral valve and valvular lesion in fourty seven patients with mitral stenosis (observed group) who were examined first time in our hospital from January to April in 1998 and were followed up during two years. Results Valvular lesion and TSS downstream of mitral stenosis in observed group presented an obviously aggravating tendency ( P <0.05), and the two correlated with each other ( r =0.82,0.86). Besides, there was a corresponding relationship spacially between magnitude and distribution of TSS and severity of lesion in the different parts of leaflet. Conclusion All above indicate that TSS downstream of mitral stenosis is an important cause that leads to progressive aggravation of valvular lesion, and it should not be neglected. The mechanism needs to be revealed through further study.

关 键 词：二尖瓣狭窄 湍流剪应力 瓣膜损害 人体 

分 类 号：R654.2[医药卫生—外科学]