肥厚型心肌病室性早搏分级与心肌纤维化程度的关系研究  

The relativity between Lown's classification of premature ventricular contraction and severity of myocardial fibrosis in hypertrophic cardiomyopathy patients

作　　者：高红玲[1] 张怡[2] 许华燕[2] 

机构地区：[1]四川大学华西医院心内科,四川成都610041 [2]四川大学华西医院放射科,四川成都610041

出　　处：《实用心电学杂志》2017年第1期39-42,46,共5页Journal of Practical Electrocardiology

摘　　要：目的探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)室性早搏(室早)分级与心肌纤维化程度的相关性。方法对59例HCM患者进行心脏磁共振扫描及24 h动态心电图检查,得到其延迟强化(late gadolinium enhancement,LGE)参数(代表心肌纤维化程度)和室早的发生情况。按照室早的Lown分期对患者进行分组,组间比较心肌LGE参数的差异,并通过Spearman相关分析得出心肌LGE参数与室早严重程度的相关性。结果所有患者中共发生室早43例(72.88%)。Lown分期0级的患者有16例,1级6例,2级3例,3级18例,4级16例。Lown分期4级患者的LGE率、总LGE体积和总LGE质量分别为(34.05±14.53)%、(66.33±29.96)m L和(66.81±30.35)g,均显著高于0~3级患者(P<0.05)。Lown分期3级患者的上述数值分别为(26.86±12.91)%、(38.62±25.23)m L和(36.98±24.06)g,均显著高于0~2级患者但低于4级患者(P<0.05)。Lown分期0级患者的上述数值分别为(15.93±11.35)%、(18.62±16.19)m L和(17.64±15.40)g,均显著低于1~4级患者(P<0.05)。LGE率、总LGE体积和总LGE质量均与Lown分期呈正相关(相关系数r分别为0.639、0.640和0.551,P<0.000 1)。结论 HCM患者室早的严重程度与心肌纤维化程度呈正相关,室早的Lown分期越高,其心肌纤维化程度也越重。Objective To investigate the relativity between Lown’s classification of premature ventricular contraction（PVC）and the severity of myocardial fibrosis in hypertrophic cardiomyopathy （HCM）patients.Methods Fifty-nine HCM patients underwent cardiac magnetic resonance scan-ning and 24 h Holter examination,thereby we obtained late gadolinium enhancement（LGE,charac-terizing the severity of myocardial fibrosis）and the occurrence of PVC.The patients were grouped by Lown’s classification and myocardial LGE was compared.By Spearman correlation analysis,the relativity between LGE and the severity of PVC was analyzed.Results PVC occurred in 43 patients （72.88%）.According to Lown＇s classification,there were 1 6 patients in grade 0,6 in grade 1 ,3 in grade 2,1 8 in grade 3 and 1 6 in grade 4.The LGE rate,total LGE volume and total LGE mass of grade-4 patients were （34.05 ±1 4.53）%,（66.33 ±29.96）mL and （66.81±30.35）g,re-spectively,all significantly higher than those of grade-0 3 patients（P 〈0.05）.The above values of grade-3 patients were separately （26.86 ±1 2.91 ）%,（38.62±25.23）mL and （36.98±24.06）g,all significantly higher than those of grade-0 2 patients but significantly lower than those of grade-4 patients（P 〈0.05 ）.The above values of grade-0 patients were separately （1 5.93±1 1 .35）%,（1 8.62±1 6.1 9）mL and （1 7.64±1 5.40）g,all significantly lower than those of grade-1 4 patients（P 〈0.05）.The LGE rate,total LGE volume and total LGE mass were all posi-tively correlated with Lown’s classification（correlation coefficient r =0.639,0.640 and 0.551 ,re-spectively;P 〈0.000 1 ）.Conclusion The severity of PVC in HCMpatients were positively corre-lated with the degree of myocardial fibrosis.The higher the grade of Lown’s classification,the more severe the degree of myocardial fibrosis.

关 键 词：肥厚型心肌病 室性早搏 心肌纤维化 延迟强化 

分 类 号：R542.2[医药卫生—心血管疾病]