非梗阻性肥厚型心肌病临床诊断及鉴别诊断  

Clinical diagnosis and differential diagnosis of non-obstructive hypertrophic cardiomyopathy

作　　者：曾文波 金岩 赵洋 尹宗涛 于立明 ZENG Wen-bo;JIN Yan;ZHAO Yang;YIN Zong-tao;YU Li-ming(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管外科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2023年第4期227-232,共6页Trauma and Critical Care Medicine

摘　　要：目的分析非梗阻性肥厚型心肌病(NOHCM)与重度高血压(HP)的超声心动图特点,为NOHCM的临床诊断及与心肌肥厚患者的鉴别诊断提供依据。方法选取自2018年1月至2022年3月北部战区总医院收治的130例确诊为NOHCM患者为NOHCM组,选取同期收治的83例重度HP患者(室间隔厚度≥15 mm)为重度HP组。回顾性分析两组患者超声心动图数据资料。结果多因素分析结果显示,NOHCM患者的主动脉根部内径更小、室间隔更厚、右室流出道内径偏小、室间隔瓣环处舒张晚期峰速(Ai’)更小、二尖瓣舒张早期峰速/室间隔瓣环处舒张早期峰速(Em/Ei’)更大、二尖瓣舒张晚期峰速(Am)更小(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,以Em/Ei’为检验变量时,ROC曲线下面积(AUC)最大,AUC为0.790(95%可信区间:0.700~0.880,P<0.001),截断值为12.60,敏感度为60.8%,特异度为68.7%。结论与重度HP比较,NOHCM患者的主动脉根部内径较小、常合并有右室心肌肥厚、左室舒张功能更低,当发现心肌肥厚患者超声心动图的Em/Ei’>12.60时,需要结合心电图诊断是否为NOHCM。Objective To analyze the echocardiographic characteristics of non-obstructive hypertrophic cardiomyopathy(NOHCM)and severe hypertension(HP),and to provide evidence for the clinical diagnosis of NOHCM and the differential diagnosis of patients with myocardial hypertrophy.Methods A total of 130 patients diagnosed with NOHCM admitted to the General Hospital of the Northern Theater Command from January 2018 to March 2022 were selected as the NOHCM group,and 83 patients with severe HP(ventricular septum thickness≥15 mm)admitted during the same period were selected as the severe HP group.The echocardiographic data of the two groups were analyzed retrospectively.Results Multi-factor analysis showed that NOHCM patients had smaller aortic root diameter,thicker ventricular septum,smaller right ventricular outflow diameter,smaller late diastolic peak velocity at ventricular septal valve ring(Ai’),larger early mitral diastolic peak velocity/early diastolic peak velocity at ventricular septal valve ring(Em/Ei’),and smaller late mitral diastolic peak velocity(Am),(P<0.05).Receiver operating characteristic(ROC)curve analysis results showed that when Em/Ei’was used as the test variable,the area under ROC curve(AUC)was the largest,with an AUC of 0.790(95%confidence interval:0.700-0.880,P<0.001),truncation value of 12.60,sensitivity of 60.8%,specificity of 68.7%.Conclusion Compared with severe HP,patients with NOHCM have smaller aortic root diameter,usually complicated with right ventricular hypertrophy,and lower left ventricular diastolic function.When Em/Ei’of patients with myocardial hypertrophy is found to be over 12.60,it is necessary to diagnose NOHCM with electrocardiogram.

关 键 词：非梗阻性肥厚型心肌病 重度高血压 心肌肥厚 超声心动图 

分 类 号：R542.2[医药卫生—心血管疾病]