主动脉瓣退行性变的临床研究  

Clinical study of degenerative disease of aortic valvular

作　　者：王道彧 孙静[1] 白云鹏 郭志刚[1] 王联群[1] Wang Daoyu;Sun Jing;Bai Yunpeng;Guo Zhigang;Wang Lianqun(Tianjin Chest Hospital.Tianjin,300222,China)

机构地区：[1]天津市胸科医院,天津300222

出　　处：《齐齐哈尔医学院学报》2022年第8期725-730,共6页Journal of Qiqihar Medical University

基　　金：天津市卫计委面上项目(2014KY34)。

摘　　要：目的 回顾分析主动脉瓣退行性变患者的人口学和临床特征、危险因素及瓣膜置换手术的效果,为本病的预防和治疗提供理论依据。方法 收集2014—2016年本院心脏外科收治的因主动脉瓣疾病行主动脉瓣置换手术的120例患者的临床资料,根据主动脉瓣跨瓣峰流速,分为轻度主动脉狭窄组(38例)、中度主动脉狭窄组(19例)和重度主动脉狭窄组(63例)共三组。统计患者与心血管危险因素有关的临床资料,比较三组患者的人口学及临床特征。选取与重度主动脉瓣狭窄组的性别、年龄相匹配的正常人群作为对照组(79例),比较重度主动脉瓣狭窄组和对照组的与主动脉瓣退行性变有关的危险因素。结果 与重度主动脉瓣狭窄组的患者比较,轻度主动脉瓣狭窄组、中度主动脉瓣狭窄伴关闭不全患者的左室舒张末内径大(P<0.001);与轻度主动脉瓣狭窄组、中度主动脉瓣狭窄组的患者比较,重度主动脉瓣狭窄组患者的室间隔厚度、左室后壁厚度增加(P<0.001,P=0.012;P<0.001,P=0.021)。重度主动脉瓣狭窄组患者的脑钠肽水平显著高于轻度主动脉瓣狭窄组的患者(P=0.006)。差异具有统计学意义。主动脉瓣跨瓣峰值压差与左室后壁厚度、室间隔厚度和脑钠肽水平正相关。通过主动脉瓣峰流速,计算主动脉瓣跨瓣峰值压差(主动脉瓣跨瓣峰值压差=4×主动脉瓣峰值流速2),主动脉瓣跨瓣峰值压差与左室后壁厚度、室间隔厚度、BNP水平正相关,相关系数分别为r=0.637(P<0.001);r=0.603(P<0.001);r=0.490(P=0.001)。差异具有统计学意义。重度主动脉瓣狭窄组患者与对照组进行危险因素的比较,发现重度主动脉瓣狭窄组的患者中具有吸烟史的比例增加(χ^(2)=4.579,P=0.043),具有高血压病史的比例增加(χ^(2)=5.904,P=0.021),总胆固醇水平更高(t=4.353,P=0.049),差异均具有统计学意义。主动脉瓣置换手术后死亡率<1%,低于天津胸科医院心Objective To analysis demographic characteristics, clinical features, risk factors, and the efficacy of valve replacement of patients with degenerative aortic valvular disease, in order to provide the theoretical basis for prevention and treatment the disease. Methods The clinical data of 120 patients aortic valve replacement due to aortic valve disease in Tianjin chest hospital from 2014 to 2016 were collected. According to the transvalvular peak velocity of aortic valve, patients are divided into mild(n=38), moderate(n=19) and severe(n=63) aortic stenosis groups. Record their clinical data related to cardiovascular risk factors, and compare demographic characteristics and clinical features of patients. 79 cases of normal controls selected to match the patients with severe aortic stenosis on gender and age, to compare risk factors of aortic degeneration in aortic valve between the patients with severe aortic stenosis and the health controls.Results Compared with patients with severe aortic stenosis, patients with mild and moderate aortic stenosis with incomplete closure had a larger left ventricular end-diastolic diameter(P<0.001). Patients with severe aortic stenosis had increased ventricular septal thickness and left ventricular posterior wall thickness(P<0.001, P=0.012) compared with patients with mild and moderate aortic stenosis(P<0.001, P=0.021).The level of brain natriuretic peptide in patients with severe aortic stenosis was significantly higher than that in patients with mild stenosis(P=0.006). The peak differential pressure of aortic valve was positively correlated with left ventricular posterior wall thickness, ventricular septum thickness and brain natriuretic peptide level.The peak differential pressure of the aortic valve was calculated by the peak flow rate of the aortic valve(peak differential pressure of the aortic valve =4× square of peak flow rate of the aortic valve). The peak differential pressure of the aortic valve was positively correlated with the thickness of the left ventricular poste

关 键 词：主动脉瓣 退行性变 临床研究 危险因素 回归方程 

分 类 号：R654.2[医药卫生—外科学]