主动脉支架置入对大动脉炎所致中主动脉综合征患者左心室功能和结构的影响  

Impact of Stent Implantation on Left Ventricular Function and Structure in Patients With Middle Aortic Syndrome Caused by Takayasu Arteritis:Mid-term Follow-up Results

作　　者：华倚虹[1] 车武强 马文韬[1] 董徽[1] 何际宁 邹玉宝[1] 蒋雄京[1] HUA Yihong;CHE Wuqiang;MA Wentao;DONG Hui;HE Jining;ZOU Yubao;JIANG Xiongjing(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,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,北京市100037 [2]中日友好医院心脏科

出　　处：《中国循环杂志》2021年第12期1191-1197,共7页Chinese Circulation Journal

基　　金：国家青年科学基金(81700440)。

摘　　要：目的:评估主动脉支架置入对大动脉炎(TA)所致中主动脉综合征(MAS)患者左心室功能和结构的影响。方法:回顾性检索2000年4月至2019年11月在中国医学科学院阜外医院住院的TA患者,收集所有诊断为TA-MAS并接受主动脉支架置入治疗的患者资料,并进行术后随访,比较支架置入治疗前后患者左心室质量指数(LVMi)、左心室射血分数(LVEF)变化,分析影响其转归的因素。结果:共62例TA-MAS患者接受主动脉支架置入治疗,平均年龄(31.3±13.0)岁,女性47例(75.8%)。其中55例(88.7%)病变位于胸主动脉中远段及跨肾动脉开口的腹主动脉。所有患者均成功置入自膨型裸支架,术后即刻病变主动脉最小管径从(5.7±2.1)mm升至(10.0±2.8)mm(P<0.001),即刻跨狭窄峰值收缩压差(PSG)从(75.6±20.6)mmHg(1 mmHg=0.133 kPa)降至(18.7±6.8)mmHg(P<0.001)。中位随访时间0.80(0.36,2.31)年,LVMi从(125.8±51.4)g/m^(2)降至(103.4±39.4)g/m^(2)(P<0.001),LVEF从(60.1±13.2)%升至(62.7±9.7)%(P<0.001)。多元线性回归分析显示基线PSG与中位随访时间0.80(0.36,2.31)年时LVMi改善率显著相关(β=0.003,95%CI:0.000~0.006,P=0.027),即基线PSG每增加1 mmHg,术后LVMi改善率增加0.3%。结论:主动脉支架置入可有效改善TA-MAS患者的左心室功能和结构,术前PSG越大的患者,支架置入治疗后改善越明显。Objectives:To evaluate the impact of stenting on cardiac function and structure in patients with middle aortic syndrome(MAS)caused by Takayasu arteritis(TA).Methods:The data of patients with TA-MAS,who received stent implantation in Fuwai Hospital from April 2000 to November 2019,were retrospectively collected and analyzed.Changes of indexes such as left ventricular mass index(LVMi),left ventricular ejection fraction(LVEF)before and after stent implantation were analyzed.Results:A total of 62 TA-MAS patients were included,the average age of patients was(31.3±13.0)years old,47 cases were female(75.8%),renal artery or proximal renal artery was involved in 55 cases(88.7%).All patients were treated with self expanded bare metal stents.The minimum diameter of aorta increased from(5.7±2.1)mm to(10.0±2.8)mm after treatment,and the peak systolic pressure gradient(PSG)across lesion decreased from(75.6±20.6)mmHg(1 mmHg=0.133 kPa)to(18.7±6.8)mmHg after treatment.After a median follow-up of 0.80(0.36,2.31)years,LVMi decreased from(125.8±51.4)g/m^(2)to(103.4±39.4)g/m^(2),and LVEF increased from(60.1±13.2)%to(62.7±9.7)%(all P<0.001).Multiple linear regression analysis showed that baseline PSG was significantly correlated with the LVMi%during the 0.80(0.36,2.31)years follow-up(β=0.003,95%CI:0.000-0.006,P=0.027),1 mmHg higher baseline PSG was associated 0.3%LVMi improvement post intervention.Conclusions:Stenting can effectively improve left ventrical function and structure in patients with TA-MAS,and higher baseline PSG is associated with more obvious improvement of left ventrical function and structure in this patient cohort.

关 键 词：大动脉炎 中主动脉综合征 支架置入 左心室质量指数 心功能 

分 类 号：R54[医药卫生—心血管疾病]