不同类型主动脉瓣病变对行主动脉瓣置换患者围术期左心室心肌肥厚情况的影响  

Effects of different types of Aortic valve on left ventricular hypertrophy in patients undergoing aortic valve replacement

作　　者：张聪 满红 王莹莹 许丹 梁久莉 李春梅 徐丽微 Zhang Cong;Man Hong;Wang Yingying;Xu Dan;Liang Jiuli;Li Chunmei;Xu Liwei(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,沈阳110016

出　　处：《中国临床实用医学》2024年第1期40-45,共6页China Clinical Practical Medicine

基　　金：沈阳市科技计划项目(21-171-9-02)。

摘　　要：目的探讨不同类型主动脉瓣病变对行主动脉瓣置换(AVR)患者围术期左心室心肌肥厚情况的影响。方法本研究为回顾性病例对照研究,选取2020年5月至2023年6月北部战区总医院心血管外科收治的248例重度慢性主动脉瓣病变患者,男126例,女122例,年龄(68.20±7.53)岁,年龄范围60~75岁,根据瓣膜病变类型将患者分为瓣膜狭窄组(n=80)、瓣膜关闭不全组(n=80)及狭窄合并关闭不全组(n=88),瓣膜狭窄组为患者主动脉瓣重度狭窄,瓣膜关闭不全组为患者主动脉瓣重度关闭不全,狭窄合并关闭不全组为患者主动脉瓣重度狭窄合并主动脉瓣重度关闭不全;比较手术前后三组患者肾小球滤过率(GFR)、左心室质量指数(LVMI)、血清胱抑素C(Cys C)水平。结果术后7 d,瓣膜狭窄组、瓣膜关闭不全组及狭窄合并关闭不全组患者Cys C[(1.15±0.27)mg/L、(1.94±0.36)mg/L、(1.29±0.36)mg/L]、LVMI[(127.19±9.51)g/m^(2)、(144.90±6.25)g/m^(2)、(129.20±4.25)g/m^(2)]水平比较,差异有统计学意义(P<0.05)。瓣膜狭窄组Cys C水平低于瓣膜关闭不全组,狭窄合并关闭不全组Cys C水平低于瓣膜关闭不全组,瓣膜狭窄组LVMI水平低于瓣膜关闭不全组,狭窄合并关闭不全组LVMI水平低于瓣膜关闭不全组,差异有统计学意义(P<0.05)。结论AVR术后早期主动脉瓣关闭不全患者心肌肥厚加重情况较瓣膜狭窄患者及瓣膜狭窄合并关闭不全组患者严重。Objective To investigate the effect of different types of aortic valve diseases on left ventricular hypertrophy in patients undergoing aortic valve replacement(AVR).Methods This study was a retrospective case-control study,a total of 248 patients who received with severe chronic aortic valve disease admitted to the department of Cardiovascular Surgery in General Hospital of Northern Theater Command from May 2020 to June 2023,including 126 males and 122 females,aged(68.20±7.53)years old,ranging form 60 to 75 years old.According to the type of valvular lesions,the patients were divided into valvular stenosis group(n=80),valvular insufficiency group(n=80)and combined group(n=88),the valve stenosis group was severe aortic stenosis,the valvular insufficiency group was severe aortic regurgitation,and the combined group was severe aortic stenosis combined with severe aortic regurgitation.The differences in left ventricular mass index(LVMI)and serum cystatin C(Cys C)values between the three groups before and after surgery were compared.Results At 7 days after surgery,the levels of Cys C[(1.15±0.27)mg/L,(1.94±0.36)mg/L,(1.29±0.36)mg/L]and LVMI[(127.19±9.51)g/m^(2),(144.90±6.25)g/m^(2),(129.20±4.25)g/m^(2)]were compared among patients with valvular stenosis group,valvular insufficiency group and combined group,the differences were statistically significant(P<0.05).The levels of Cys C in the valvular stenosis group were lower than that in the valvular insufficiency group,the levels of Cys C in the combined group were lower than that in the valvular insufficiency group.The levels of LVMI in the valvular stenosis group were lower than that in the valvular insufficiency group,the levels of LVMI in the combined group were lower than that in the valvular insufficiency group,the differences were statistically significant(P<0.05).Conclusions Myocardial hypertrophy was more severe in patients with early aortic regurgitation after AVR than in patients with valvular stenosis and patients with valvular stenosis combined with re

关 键 词：左心室质量指数 主动脉瓣置换 左心室心肌肥厚 胱抑素C 

分 类 号：R654.2[医药卫生—外科学]