梗阻性肥厚型心肌病患者发生肺高血压的病例对照研究  

Prevalence of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy： a case-control study

作　　者：伍熙[1] 崔颢[2] 肖明虎[3] 鲁洁[1] 朱昌盛[2] 王水云[2] 黄晓红[1] Wu Xi Cui Hao Xiao Minghu Lu fie Zhu Changsheng Wang Shuiyun Hnang Xiaohong(Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China)

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医院心内科,100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声科,100037

出　　处：《中华心血管病杂志》2016年第12期1010-1014,共5页Chinese Journal of Cardiology

基　　金：首都临床特色应用研究项目（Z161100000516454）

摘　　要：目的探讨梗阻性肥厚型心肌病（HOCM）患者发生肺高血压的临床特点及其危险因素。方法入选2011年3月至2015年12月于阜外医院住院的HOCM患者301例，统计其合并肺高血压的情况和严重程度。将入选患者分为2组，即对照组和肺高血压组，比较两组患者的临床差异。采用logistic回归分析HOCM患者肺高血压的危险因素。结果301例HOCM患者中，发生肺高血压者37例（12．3％），其中肺高血压轻度者18例（48．6％），中度15例（40．5％），重度4例（10．8％）。多因素logistic回归分析发现女性（OR=3．95，95％CI1．74～8．98，P=0．001）、年龄≥65岁（OR=3．87，95％CI1．16～12．97，P=0．030）、心房颤动（OR=2．76，95％CI1．01—7．57，P=0．049）和二尖瓣中、重度反流（OR=6．63，95％CI3．02～14．57，P=0．000）是肺高血压的独立危险因素。根据性别分层后显示，年龄≥65岁（OR=7．79，95％CI1．35—47．26，P〈0．05）和二尖瓣中、重度反流（OR=9．83，95％C12．26～42．67，P〈0．01）是男性患者肺高血压的独立危险因素，而心房颤动（OR=6．32，95％CI1．57—25．40，P=0．01）和二尖瓣中、重度反流（OR=5．23，95％CI1．92～14．26，P〈0．01）是女性患者肺高血压的独立危险因素。轻度肺高血压和中、重度肺高血压两组患者间危险因素差异无统计学意义。结论合并肺高血压的HOCM患者年龄偏大，女性较多，静息梗阻、房颤以及二尖瓣中、重度反流比例较高。女性、高龄、心房颤动和二尖瓣中、重度反流是HOCM患者发生肺高血压的独立危险因素。Objective To explore the clinical characteristics and risk factors of pulmonary hypertension （PH） in patients with hypertrophic obstructive cardiomyopathy （HOCM）. Methods A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study. Incidence rate and severity of PH were depicted. The study population was divided into two groups （PH group and control group）,and the differences in clinical profile were elucidated. Risk factors of PH in patients with HOCM were assessed by multivariate logistic regression analysis. Results The incidence of PH was 12. 3% （37 cases）, in which 48.6% patients （18 cases） were mild PH, 40.5% patients （15 cases） were moderate PH, and patients with severe PH accounts for 10. 8% （4 cases）. Multivariate logistic regression analysis indicated that female （ OR = 3.95,95 % CI 1.74 - 8.98, P = 0. 001 ）, age 〉/65 years （ OR = 3.87, 95% CI 1.16 - 12. 97, P = 0. 030 ）, history of atrial fibrillation （ OR = 2.76,95% CI 1.01 - 7.57, P = 0. 049） and moderate or severe mitral regurgitation （ OR = 6. 63,95% CI 3.02 - 14. 57, P = 0. 000 ） were independent risk factors of PH. Stratification according to sex showed that age ≥65 years（ OR =7.79,95% CI 1.35 - 47.26, P 〈 0. 05 ） and moderate or severe mitral regurgitation （ OR = 9. 83,95 % CI 2. 26 - 4：2.67, P 〈 0.01 ）were independent risk factors of PH for male patients; while history of atrial fibrillation （OR =6. 32,95% CI 1.57 - 25.40, P = 0. 01 ） and moderate or severe mitral regurgitation （ OR = 5.23,95% CI 1.92 - 14. 26 ,P 〈0. 01 ）were independent risk factors of PH for female patients. Risk factors were similar between the mild PH group and moderate to severe PH groups. Conclusion Compared with patients without PH, HOCM patients complicated with PH were older and with higher percentage of female, and resting obstruction, history of atrial fibrillation and moderate or severe mitral regurgitation. Independent risk factors for PH in obstructive

关 键 词：心肌病 肥厚性 高血压 肺性 危险因素 

分 类 号：R542.2[医药卫生—心血管疾病]