不同肥厚部位的肥厚型心肌病合并冠心病患者的临床预后研究  

A clinical prognostic study on patients with HCM combined with coronary heart disease in different hypertrophic areas

作　　者：胡靖超[1] 许左隽[1] 陈启稚[1] 尹萍[1] Hu Jingchao;Xu zuojuan;Chen Qizhi;Yin ping(Department of Cardiology,Ninth People's Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海200011

出　　处：《中国循证心血管医学杂志》2025年第2期232-236,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨不同肥厚部位的肥厚型心肌病(HCM)合并冠状动脉粥样硬化性心脏病(冠心病)的临床特点和预后以及相关影响因素。方法收集2018年1月至2022年6月于上海交通大学医学院附属第九人民医院心内科住院治疗的HCM合并冠心病77例患者作为观察组,将其又分为室间隔肥厚型(室间阻隔)、心尖部肥厚型(心尖组)、其他肥厚部位型(其他组)三个亚组,选择同期住院的无HCM的冠心病患者63例作为对照组,记录所有患者的一般资料临床症状、临床检查和随访不良心血管事件并进行比较分析,按照不良心血管事件发生与否分为不良预后亚组、预后良好亚组,对两亚组资料进行比较分析,采用Logistic多因素回归分析预后影响因素。结果室间隔组晕厥发生比例高于对照组和心尖组(P<0.05),室间隔组收缩压高于对照组(P<0.05),室间隔组、心尖组和其他组左室射血分数(LVEF)低于对照组(P<0.05),心尖组和其他组LVEF高于室间隔组(P<0.05);对照组、室间隔组和其他组发生左前降支病变血管比例高于心尖组(P<0.05);心尖组及对照组无血管狭窄患者比例高于室间隔组(P<0.05);室间隔组1支血管狭窄程度>75%的患者比例高于心尖组及对照组(P<0.05)。室间隔组不良心血管事件发生率为57.58%,显著高于心尖组26.09%、其他组19.05%和对照组15.87%,(P<0.05)。对比不良预后与预后良好亚组发现在年龄、收缩压、高胆固醇血症、LVEF、冠状动脉累计数目和血管狭窄程度等方面比较,具有统计学意义(P<0.05)。经多因素Logistic回归分析,发现年龄(P=0.023,OR=2.104),LVEF(P=0.016,OR=0.903),血管狭窄程度(P=0.005,OR=3.273)和冠状动脉累计数目(P=0.024,OR=1.138)是HCM合并冠心病预后的影响因素。结论不同肥厚部位的HCM合并冠心病患者中,室间隔肥厚型患者发生晕厥比例较高,血管狭窄程度较重,预后较差,年龄、LVEF、血管狭窄程度和冠状动脉累计数Objective To investigate the clinical characteristics and prognosis of hypertrophic cardiomyopathy(HCM)with coronary atherosclerotic heart disease(CHD)at different hypertrophic sites,as well as the prognostic factors.Method 77 patients with HCM complicated with coronary heart disease who were hospitalized in the Department of Cardiology,Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to June 2022 were collected as the observation group.Patients in the observation group were divided into three groups based on different locations of myocardial hypertrophy:interventricular septal hypertrophy,apical hypertrophy,and other types of hypertrophy.At the same time,63 patients with coronary heart disease without HCM who were hospitalized during the same period were selected as the control group.Record the general information,clinical symptoms,clinical examination data,and follow-up adverse cardiovascular events of all patients and conduct comparative analysis.Divide them into subgroups with poor prognosis and subgroups with good prognosis based on the occurrence of adverse cardiovascular events.Compare and analyze the data of the two subgroups,and use logistic multiple regression to analyze the prognostic factors.Results The incidence of syncope in the interventricular septum group was higher than that in the control group and apical group(P<0.05),the systolic blood pressure in the interventricular septum group was higher than that in the control group(P<0.05),the left ventricular ejection fraction in the interventricular septum group,apical group,and other groups was lower than that in the control group(P<0.05),and the left ventricular ejection fraction in the apical group and other groups was higher than that in the apical group(P<0.05),The proportion of patients without vascular stenosis in the apex group and control group was higher than that in the interventricular septum group(P<0.05),and the proportion of patients with one vessel stenosis degree greater than 75

关 键 词：肥厚型心肌病 冠状动脉粥样硬化性心脏病 预后 影响因素 

分 类 号：R542.2[医药卫生—心血管疾病]