中国中重度主动脉瓣疾病患者的临床特点及预后:来自China-VHD研究的分析  

Characteristics,Management and Prognosis of Patients With Moderate and Severe Aortic Valve Disease in China:From China-VHD Study

作　　者：李喆[1] 郭帅[1] 叶蕴青[1] 刘庆荣[1] 赵振燕[1] 赵庆豪 张斌[1] 王玮玮[1] 段振娅 吕俊兴 于子凯 张海彤 王彬成 许海燕[1] 吴永健[1] 高润霖[1] LI Zhe;GUO Shuai;YE Yunqing;LIU Qingrong;ZHAO Zhenyan;ZHAO Qinghao;ZHANG Bin;WANG Weiwei;DUAN Zhenya;LYU Junxing;YU Zikai;ZHANG Haitong;WANG Bincheng;XU Haiyan;WU Yongjian;GAO Runlin(Coronary Heart Disease Center,National Center for Cardiovascualr 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冠心病中心,北京市100037

出　　处：《中国循环杂志》2022年第4期322-328,共7页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程(2017-12M-3-002);首都卫生发展科研专项(首发2020-1-4031)。

摘　　要：目的:描述中国中重度主动脉瓣疾病(AVD)的类型、发病特点、诊治情况和患者预后。方法:中国瓣膜性心脏病注册登记研究(China-VHD)于2018年4~6月前瞻性注册登记46家医院13917例≥18岁门诊和住院瓣膜病患者,描述其中中重度AVD病变类型、病因、临床特征、诊治情况及患者2年预后。结果:4148例(29.8%)患者存在中重度AVD。其中,单纯主动脉瓣反流(AR)占38.8%,单纯主动脉瓣狭窄(AS)占13.9%,AS+AR占6.8%,主动脉瓣联合其他瓣膜病(MVD)占40.5%。在单纯AS患者中,73.5%的18~44岁患者病因为先天性病变,66.1%的≥60岁患者为退行性病变。在单纯AR患者中,38.2%的18~44岁患者病因为先天性病变,60.9%的≥60岁患者为退行性病变。中重度AVD患者的总体瓣膜手术治疗率为47.1%。其中,40.4%接受外科瓣膜置换术,11.9%接受外科瓣膜修补术,2.9%接受经导管主动脉瓣置换术。接受手术治疗的患者院内死亡率为0.4%。重度AVD手术治疗率在≥60岁及MVD患者中最低。2年随访结果显示,与单纯药物治疗的患者相比,接受手术治疗的患者死亡率明显较低(11.5%vs.2.5%,P<0.05)。结论:AVD中AR是最常见类型。随年龄增加,退行性病因增加,手术治疗率下降;手术治疗较单纯药物治疗可降低2年死亡率。Objectives:To describe the distribution,characteristics,diagnosis and treatment of moderate and severe aortic valve disease(AVD)in China.Methods:From April to June 2018,China-VHD prospectively registered 13917 outpatients and inpatients aged≥18 years in 46 hospitals with valvular heart disease.Patients with moderate to severe AVD in China-VHD was selected to describe composition,etiology,characteristics,treatment and 2-year prognosis.Results:The proportion of patients with moderate and severe AVD was 29.8%(4148/13917).Percent of aortic regurgitation(AR),aortic stenosis(AS),AS+AR and mulitivalvular heart disease(MVD)was 38.8%,13.9%,6.8%and 40.5%,respectively.Congenital factor was the most common etiology of young patients(18-44 years old)of AS,and degenerative AS increased with age.The operative intervention rate of patients with AVD was 47.1%.The proportion of patients treated with surgical aortic valve replacement,surgical aortic valve repair and transcatheter aortic valve replacement was 40.4%,11.9%and 2.9%,respectively.The in-hospital mortality of patients with operative intervention treatment was 0.4%.The overall 2-year mortality rate significantly lower in patients receiving operative interventional therapy as compared to medical therapy alone(2.5%vs.11.5%,P<0.05).Conclusions:AR was the most common in AVD.The degenerative etiology increased,but operative intervention rate decreased with aging.Two-year mortality could be significantly reduced by operative intervention as compared with medical therapy alone.

关 键 词：主动脉瓣狭窄 主动脉瓣反流 构成特点 诊治情况 队列研究 

分 类 号：R54[医药卫生—心血管疾病]