肥厚型梗阻性心肌病患者非持续性室性心动过速的危险因素分析  

Analysis of risk factors of nonsustained ventricular tachycardia in patients with hypertrophic obstructive cardiomyopathy

作　　者：聂长荣 朱昌盛[1] 肖明虎[2] 蒙延海[3] 杨秋蓝[3] 王水云[1] Nie Changrong;Zhu Changsheng;Xiao Minghu;Meng Yanhai;Yang Qiulan;Wang Shuiyun(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Ultrasound,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Intensive Care Unit,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences 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成人外科中心,北京100037 [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超声科,北京100037 [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重症监护室,北京100037

出　　处：《中国心血管杂志》2021年第6期550-554,共5页Chinese Journal of Cardiovascular Medicine

基　　金：首都卫生发展科研专项(2020-2-4036)。

摘　　要：目的探究肥厚型梗阻性心肌病(HOCM)患者非持续性室性心动过速(nsVT)的危险因素。方法连续性纳入2015年1月至2017年12月在阜外医院成人外科中心七病区诊断为HOCM且术前完善24 h动态心电图的患者411例。根据动态心电图结果分为nsVT组和非nsVT组。比较两组患者的临床资料差异,并采用多因素logistic回归分析HOCM患者nsVT的危险因素。结果在411例患者中,53例检出nsVT(12.9%),阵次2(1,2.5)阵(范围:1~97阵),最长阵次持续时间为5(4,8)个(范围:3~35个)室性期前收缩,最快心室率平均为(131.4±22.1)次/min。nsVT组患者的糖尿病患病率显著高于非nsVT组(9.4%比2.2%,χ^(2)=7.812,P<0.01);nsVT组患者的左心室后壁厚度[(12.7±2.7)mm比(11.8±2.5)mm,t=-2.401,P=0.02]和左心室壁最大厚度[(22.9±4.5)mm比(21.3±4.5)mm,t=-2.412,P=0.02]显著大于非nsVT组;nsVT组患者的左心室中部梗阻的发生率显著高于非nsVT组(22.6%比10.6%,χ^(2)=6.249,P=0.01)。多因素logistic回归分析表明,糖尿病(OR=4.48,95%CI:1.38~14.53,P=0.01)、左心室中部梗阻(OR=2.14,95%CI:1.02~4.51,P=0.045)和左心室壁最大厚度(OR=1.08,95%CI:1.01~1.15,P=0.02)是nsVT的独立危险因素。结论糖尿病、左心室中部梗阻及左心室壁最大厚度增加是HOCM患者nsVT的独立危险因素。Objective To investigate the risk factors of nonsustained ventriuclar tachycardia(nsVT)in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods Four hundred and eleven consecutive patients diagnosed HOCM in Fuwai Hospital between 2015 to 2017 were enrolled.We divided patients into two groups:patients with nsVT group and patients without nsVT group according to the result of 24-h Holter electrocardiography.Clinical parameters were compared between the two groups.Results A total of 53 patients(12.9%)had nsVT during their initial Holter ECG recording.The mean number of runs of nsVT in 24-h was 2(1,2.5)(range,1 to 97).The mean number of beats of the longest run was 5(4,8)beats(range,3 to 35 beats)and the mean maximum rate of the nsVT runs was 131.4±22.1 beats/min.The prevalence of diabetes was significantly higher in patients with nsVT than those without nsVT(9.4%vs.2.2%,χ^(2)=7.812,P<0.01).Left ventricular posterior wall thickness(12.7±2.7 mm vs.11.8±2.5 mm,t=-2.401,P=0.02)and maximal thickness of left ventricular wall(MTLVT)(22.9±4.5 mm vs.21.3±4.5 mm,t=-2.412,P=0.02)were greater in patients with nsVT than control group patients.The proportion of mid-ventricular obstruction(MVO)were significantly higher in patients with nsVT than those without nsVT(22.6%vs.10.6%,χ^(2)=6.249,P=0.01).In multivariate analysis,diabetes(OR=4.48,95%CI:1.38-14.53,P=0.01),MVO(OR=2.14,95%CI:1.02-4.51,P=0.045)and MTLVT(OR=1.08,95%CI:1.01-1.15,P=0.02)were independent risk factors of nsVT.Conclusions Diabetes,mid-ventricular obstruction,and greater maximal thickness of left ventricular wall were independent risk factors of nonsustained tachycardia in patients with HOCM.

关 键 词：肥厚型心肌病 梗阻性 非持续性室性心动过速 危险因素 

分 类 号：R542.2[医药卫生—心血管疾病] R541.71[医药卫生—内科学]