高原地区心功能不全患者临床特征及心室扩大危险因素的观察性研究  

Clinical characteristics and risk factors of ventricular enlargement in cardiac insufficiency patients living at high altitude

作　　者：努尔比叶木·麦麦提艾力 张艳君 牛明远 平措旺加 王鹏举 米玛 德吉卓嘎 俞晴 刘盼晶 彭文辉[1,2] Nuerbiyemu·Maimaitiaili;ZHANG Yanjun;NIU Mingyuan;WANG Pengju;YU Qing;LIU Panjing;PENG Wenhui(Department of Cardiology,Tenth People's Hospital of Tongji University,Shanghai,200072,China;Department of Cardiology,Rikaze People's Hospital)

机构地区：[1]同济大学附属第十人民医院心血管内科,上海200072 [2]日喀则市人民医院心血管内科

出　　处：《临床心血管病杂志》2022年第8期659-664,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金(No:81900239)。

摘　　要：目的:分析平均海拔在4000 m地区的世居藏族人群中心功能不全患者的临床特征及其心室扩大的危险因素。方法:选取2019年3月—2020年12月日喀则市人民医院心血管内科收治的心功能不全患者216例,回顾性分析患者的临床资料及超声心动图检查指标。依据欧美超声心动图协会建议成人心腔定量标准,左室舒张末期直径>55 mm作为左室扩大,右室横径>23 mm作为右室扩大。将所有患者按照心室扩大情况分为双室大小正常组即对照组(31例)、左室扩大组(7例)、右室扩大组(122例)和双室扩大组(56例),并对超声心动图参数与各相关临床变量进行相关分析,观察患者临床特征并探讨影响心室扩大的危险因素。结果:216例患者中,NYHA分级以Ⅲ级心功能不全患者(60%)最常见。与对照组比较,右室扩大组和双室扩大组患者的心功能显著下降(P<0.05)。一般临床资料显示,右室扩大组患者红细胞计数(RBC)较对照组显著增高(P<0.05)。与右室扩大组比较,双室扩大组的高密度脂蛋白胆固醇(HDL-C)降低,低密度脂蛋白胆固醇(LDL-C)显著升高(P<0.05)。与对照组比较,左室扩大组、右室扩大组和双室扩大组的心率和NT-proBNP显著升高(均P<0.05)。超声心动图参数显示,与对照组比较,右室扩大组和双室扩大组的肺动脉主干直径和肺动脉收缩压显著升高(P<0.05)。多因素logistic回归分析结果显示,HDL-C(OR=0.177,95%CI:0.032~0.988)、NT-proBNP(OR=1.000,95%CI:1.000~1.000)、肺主动脉干直径(OR=1.123,95%CI:1.021~1.236)、肺动脉收缩压(OR=0.960,95%CI:0.927~0.995)是高原右室扩大的心功能不全患者并发左室扩大的危险因素。结论:高原心功能不全患者以右室扩大最为常见,其次为双室扩大。HDL-C降低、NT-proBNP升高、肺动脉主干直径增宽和肺动脉压降低是高原右室扩大的心功能不全患者并发左室扩大的独立危险因素。Objective: To analyze the clinical characteristics and risk factors of ventricular enlargement in Tibetan patients with cardiac dysfunction at an average altitude of 4000 m.Methods: A total of 216 patients with cardiac insufficiency admitted to the department of Cardiology of Tibetan Shigatse People's Hospital from March 2019 to December 2020 were enrolled and basic clinical data were collected.According to the quantitative standards of heart chamber recommended by the European and American echocardiography association,left ventricular end-diastolic diameter>55 mm was considered as the left ventricular enlargement and right ventricular diameter>23 mm was considered as the right ventricular enlargement.All patients were divided into four groups according to ventricular enlargement:control group(31 patients),left ventricular enlargement group(7 patients),right ventricular enlargement group(122 patients)and bi-ventricular enlargement group(56 patients).Correlation analyses between echocardiogram parameters and related clinical variables were carried out to observe the clinical characteristics and ventricular structure changes,as well as to explore the risk factors for ventricular enlargement.Results: Among 216 patients with cardiac insufficiency,NYHA gradeⅢ(60%)are the most common.Compared to the control group,the heart function of patients was significantly decreased in right ventricular enlargement group and bi-ventricular enlargement group(P<0.05).General clinical statistics showed that red blood cell count(RBC)in the right ventricular enlargement group was significantly higher than in the control group(P<0.05).The mean value of high-density lipoprotein cholesterol(HDL-C)in the bi-ventricular enlargement group was lower compared to the right ventricular enlargement group,while the mean value of low-density lipoprotein cholesterol(LDL-C)was higher(P<0.05).The heart rate and the mean value of NT-proBNP in the ventricular enlargement groups were significantly increased compared with the control group(P<0.05).Echoc

关 键 词：高原 心功能不全 心室扩大 超声心动图 肺动脉高压 

分 类 号：R541.6[医药卫生—心血管疾病]