间隔心肌消融术与药物保守治疗对梗阻性肥厚型心肌病疗效的对比  

Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy

作　　者：赵华[1] 何继强[1] 姜蓓[2] 高阅春[1] 李全[1] 吴长燕[1] 姜腾勇[1] Zhao Hua He Jiqiang Jiang Bei Cao Yuechun Li Quan Wu Changyan Jiang Tengyong.(Department of Cardiology, Anzhen Hospital Affiliated to Capital Medical University, Belting Institute of Heart Lung and Blood Vessel Disease ,Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院心内科北京市心肺血管病研究所,100029 [2]佳木斯大学附属第一医院核医学科

出　　处：《中华心血管病杂志》2016年第12期1015-1019,共5页Chinese Journal of Cardiology

摘　　要：目的探讨间隔心肌消融术（简称介入治疗）对梗阻性肥厚型心肌病（HOCM）患者血液动力学、心功能和生存率的影响，并与单纯药物治疗进行比较。方法本研究为回顾性研究。人选首都医科大学附属北京安贞医院心内科2002年9月至2014年9月住院和门诊接受诊断、评价和治疗的HOCM患者350例，平均年龄（51．3±13．5）岁，单纯药物治疗组166例、介入治疗组184例，随访4年（1～14年），随访率为99．4％（348／350）。收集人选患者的基线临床资料，并进行随访。主要观察入选患者的全因死亡、心原性死亡（包括介入围手术期、心力衰竭和猝死），另外评价介入治疗相关的起搏器依赖和心功能改善情况等。采用Cox回归分析临床事件预测因素。Kaplan—Meier生存曲线描述两组间全因生存率，组间生存差异比较采用log—rank检验。结果单纯药物治疗组和介入治疗组的患者年均死亡率分别为2．4％和0．6％（P〈0．01），心脏性猝死的发生率分别为3．61％（6／166）和0．54％（1／184）（P=0．031），二者差异均有统计学意义。多因素Cox回归分析显示年龄是全因死亡最主要的独立预测因素（HR=1．259，95％CI1．101～1．438，P=0．001）。另外，接受介入治疗的患者左心室流出道梗阻亦有所改善[从（4．23±1．05）m／s降至（1．83±0．79）m／s，P〈0．01]，纽约心脏协会心功能分级由术前的2．97±0．29降至1．74±0．53（P〈0．01）。结论介入治疗可改善HOCM患者心功能和血液动力学。与单纯药物治疗比较，介入治疗具有全因生存优势，且不增加心脏性猝死的风险。Objective To compare the effects of septal ablation （SA） versus conservative medication （CM） on the hemodynamic, clinical status and survival in patients with hypertrophic obstructive cardiomyopathy （HOCM）. Methods This retrospective study included 350 consecutive patients with HOCM （mean age （51.3 ± 13.5 ） years old） hospitalized in Anzhen Hospital between September 2002 to September 2014. The patients were followed up to 14 years and the follow up rate was 99.4% （348/350）. Overall and cardiac-related mortalities were compared between SA group （n = 184） and CM group （n = 184）. Moreover, SA related cardiac function and hemodynamics improvement were also evaluated, predictors for clinical events were evaluated by Cox regression analysis and Kaplan-Meier survival analysis was used to compare the total mortality between the two groups. The log-rank test was used to compare the survival curve differences between the two groups. Results The median follow-up period was 4 years （ 1 - 14 years）. The annual mortalities of SA and CM were 2.4% and 0. 6% respectively （ P 〈 0. 001 ） and cumulative sudden cardiac death （SCD） rates were 3.61% （6/166） and 0. 54% （ 1/184 ） respectively （P = 0. 031 ）. Multivariate regression analysis demonstrated that the age was the most important independent predictor for overall mortality （ HR = 1. 259,95 % CI 1. 101 - 1. 438, P = 0. 001 ）. In addition, left ventricular outflow tract （LVOT） gradient was significantly reduced post SA （peak velocity of LVOT： baseline （4. 23 ±1.05） m/s, post SA： （ 1.83 ±0. 79） m/s,P 〈0. 01 ） and heart function was also significantly improved postSA （ NYHA at baseline ： 2. 97 ± 0. 29 , post SA： 1.74±0.53, P〈0.001）. Conclusion SA could significantly improve the hemodynamics and clinical status in drug-resistant patients with HOCM. In comparison to patients received CM, overall survival rate was significantly higher in SA group without extra risk of SCD.

关 键 词：心肌病 肥厚性 导管消融术 治疗结果 

分 类 号：R542.2[医药卫生—心血管疾病]