肥厚梗阻型与非梗阻型心肌病的临床特点和预后分析

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (2): 195-198.

肥厚梗阻型与非梗阻型心肌病的临床特点和预后分析

唐媛媛^1,2, 唐博謇², 严晓伟², 方全²

¹皖芜湖宣城地区人民医院心内科, 芜湖241001, 安徽;
²中国医学科学院, 中国协和医科大学北京协和医院心内科, 北京100730

收稿日期:2009-01-08 修回日期:2009-02-06 出版日期:2009-02-26 发布日期:2020-10-30
通讯作者: 严晓伟, 主任医师, 教授, 博士生导师, 研究方向:冠心病、高血压病。Tel:13701178433 　E-mail:xswy-pumc@yahoo.com.cn
作者简介:唐媛媛, 女, 本科, 主治医师, 研究方向:心血管疾病。Tel:15955357038 　E-mail:tyycqm@126.com

Clinical features and prognosis of obstructive and non-obstructive hypertrophic cardiomyopathy patients

TANG Yuan-yuan^1,2, TANG Bo-jian², YAN Xiao-wei², FANG Quan²

¹People's Hosital of Xuancheng's Squail, Wuhu 241001, Anhui, China;
²Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China

Received:2009-01-08 Revised:2009-02-06 Online:2009-02-26 Published:2020-10-30

摘要/Abstract

摘要： 目的:对比分析肥厚梗阻型与非梗阻型心肌病临床特点及预后。方法:选择2003 -2006 年入院的肥厚性心肌病患者112 例, 其中肥厚梗阻型心肌病54 例, 非梗阻型58 例, 对比分析其临床资料并平均追踪随访(4.5 ±2.8) 年。结果:肥厚梗阻型与非梗阻型心肌病病人在年龄、家族史、合并症等方面差别无统计学意义, 梗阻型患者中女性的比例明显高于非梗阻型。梗阻型患者胸闷、心脏杂音等表现较为多见, 其他症状、体征及临床转归在梗阻型和非梗阻型患者之间差异无统计学意义。二尖瓣前叶收缩期前移(SAM 征) 、左心室流出道最大压差(LVOT) 、左室射血分数(LVEF) 、左房内径、二尖瓣返流等方面肥厚梗阻型心肌病与非梗阻型差异有统计学意义。随访期间临床事件发生率低, 且两组之间差别无统计学意义。结论:肥厚梗阻型与非梗阻型心肌病病人在年龄、家族史、合并症等方面差别不显著。通过积极、以β阻滞剂为主的药物治疗, 临床事件及心脏事件发生率低。

关键词: 肥厚性梗阻型心肌病, 肥厚性非梗阻型心肌病, 临床转归

Abstract: AIM: To compare and analyse the clinical features and outcomes between obstructive and non-obstructive hypertrophic cardiomyopathy (HCM). METHODS: We made a retrospective analysis of the clinical data of 112 patients(54 patients were obstructive HCM and 58 patients were non-obstructive HCM)) admitted in our hospital from 2003 to 2006 with the diagnosis of HCM, and followed up for (4.5 ±2.8) years.RESULTS: There were no significant differences in age, family history and complications between obstructive and non-obstructive HCM patients.The proportion of female patients was markedly higher in the obstructive HCM patients than that in the non-obstructive HCM patients.Besides chest distress and heart murmur were more obvious in the obstructive HCM patients, there was no significant difference between the two groups as to other clinical symptoms, signs and clinical outcome.The differences in systolic anterior motion of the mitral valve(SAM sign), maximum pressure gradient in the left ventricular outflow tract (LVOT), left ventricular ejection fraction(LVEF), left atrial diameter, mitral valve regurgitation reached sinificance between the obstructive HCM group and the non-obstructive HCM group.The incidence of clinical events was low in follow-up period, and there was no difference between the two groups.CONCLUSION: There were no significant differences in age, family history and, complications between obstructive and non-obstructive HCM patients.After β blocker-based drug treatment, the incidence of clinical and cardiac events were relatively low.

Key words: obstructive hypertrophic cardiomyopathy, non-obstructive hypertrophic cardiomyopathy, clinical outcome

中图分类号:

R542.2

唐媛媛, 唐博謇, 严晓伟, 方全. 肥厚梗阻型与非梗阻型心肌病的临床特点和预后分析[J]. 中国临床药理学与治疗学, 2009, 14(2): 195-198.

TANG Yuan-yuan, TANG Bo-jian, YAN Xiao-wei, FANG Quan. Clinical features and prognosis of obstructive and non-obstructive hypertrophic cardiomyopathy patients[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(2): 195-198.

参考文献

[1] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会, 中国心肌病诊断与治疗建议工作组.心肌病诊断与治疗建议[J].中华心血管病杂志, 2007, 35(1):5-16.
[2] Maron BJ, McKenna WJ, Danielson GK, et al.American College of Cardionogy European Soaety of cardiology. Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy:a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines[J].Eur Heart J, 2003, 24 (21):1965-1991.
[3] Maron BJ, Gardin JM, Flack JM, et al.Prevalence of hypertrophic cardiomyopathy in a general population of young adults:Echocardiographic analysis of 4111 subjects in the CARDIA Study[J].Circulation, 1995, 92(4):785-789.
[4] Maron BJ, Casey SA, Poliac LC, et al.Clinical course of hypertrophic cardiomyopathy in a regional United States cohort[J].JAMA, 1999, 281(7):650-655.
[5] Maron MS, Olivotto I, Betocchi S, et al.Effects of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy[J].N Engl J Med, 2003, 348(4):295-303.
[6] Zou Y, Song L, Wang Z, et al.Prevalence of idiopathic hypertrophic cardiomyopathy in China:a population-based echocardiographicanalysis of 8080 adults[J].Am J Med, 2004, 116(1):14-18.
[7] Olivotto I, Maron MS, Adabag AS, et al.Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy[J].J Am Coll Cardiol, 2005, 46(3):480-487.
[8] Wynne J, Braunwald E.The Cardiomyopathies[M] Zips D, Libby L, Bonow R, et al.eds.Braunwald's Heart Disease.ed 7.Philadelphia:Elsevier Saunders Publishers, 2005:1659-1717.
[9] Olivotto I, Cecchi F, Casey SA, et al.Impact of atrial fribrillation on the clinical course of hypertrophic cardiomyopathy[J].Circulation, 2001, 104(21):2517-2524.
[10] Higashikawa M, Nakamuri Y, Yoshida M, et al.Incidence of ischemic strokes in hypertrophic cardiomyopathy is markedly increased if complicated by atrial fribrillation [J].Jpn Circ J, 1997, 61(8):673-681.
[11] Cecchi F.Does LV outflow tract obstruction increase the risk of sudden death in hypertrophic cardiomyopathy[J] ? Nat Clin Prac CardiovasMed, 2007, 4(4):194-195.
[12] Elliott PM, Gimeno JR, Tome MT, et al.Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy[J].Eur Heart J, 2006, 27(16):1933-1941.

[1]	郝潇, 赵美, 王文静, 张飞飞, 刘惠良, 党懿, 李树仁, 齐晓勇. 钠-葡萄糖共转运体2抑制剂在急性心肌梗死应用研究进展[J]. 中国临床药理学与治疗学, 2023, 28(7): 824-831.
[2]	陈满新, 张丙雨, 戴敏. 冠状动脉内靶向应用重组人尿激酶原联合经皮冠状动脉成形术治疗高负荷血栓急性心肌梗死临床疗效[J]. 中国临床药理学与治疗学, 2023, 28(5): 544-549.
[3]	彭娟, 李然宜, 范琳琳, 李晓宇, 吕迁洲, 邹云增. 心肌肥厚和心室重构的药物治疗进展[J]. 中国临床药理学与治疗学, 2022, 27(4): 382-389.
[4]	谢梦蝶, 王衬衬, 李冰涛, 欧阳长生, 邱雨美, 李洪铭, 涂珺, 尚广彬, 汤喜兰. 基于体外细胞实验和网络药理学研究乳香挥发油抗心脏肥大的作用机制[J]. 中国临床药理学与治疗学, 2022, 27(3): 241-252.
[5]	傅小媚，霍然，邓赛，林潮金，范景皓，王萍，李松沛，秦爱萍，邹明辉，余细勇. 脂多糖刺激的骨髓间充质干细胞来源外泌体改善小鼠心肌梗死后炎症和纤维化[J]. 中国临床药理学与治疗学, 2019, 24(8): 841-851.
[6]	卓凤巧，黄占红，刘宇捷. 甘草素对高糖诱导心肌细胞凋亡的影响及机制[J]. 中国临床药理学与治疗学, 2019, 24(2): 147-151.
[7]	王政，汪和贵. A型激酶锚定蛋白介导的心肌肥厚调控机制的研究进展[J]. 中国临床药理学与治疗学, 2017, 22(11): 1304-1308.
[8]	宗巧凤, 程向阳, 于影, 张蔚屏, 高琴, 李正红. 内啡肽-1后处理对大鼠心肌缺血再灌注损伤的实验研究[J]. 中国临床药理学与治疗学, 2015, 20(2): 132-137.
[9]	周勇, 黄松群, 徐飞. 术前与术中使用替罗非班对急性ST段抬高心肌梗死急诊介入治疗慢血流的比较及安全性[J]. 中国临床药理学与治疗学, 2014, 19(11): 1268-1271.
[10]	潘大彬, 汪旻晖, 曹蘅. 糖尿病心肌病发病机制的研究进展[J]. 中国临床药理学与治疗学, 2013, 18(7): 831-836.
[11]	陈高勇, 张艳美, 石刚刚. ERK信号转导通路在心肌缺血再灌注损伤中的作用[J]. 中国临床药理学与治疗学, 2012, 17(2): 234-240.
[12]	邓少雄, 郭南鸥, 郑渊, 黄文森. 替罗非班对急性ST段抬高型心肌梗死并糖尿病患者急诊经皮冠状动脉介入治疗术后血清MMP-9水平的影响及临床意义[J]. 中国临床药理学与治疗学, 2011, 16(7): 807-811.
[13]	白霞, 郭志宏, 张璠, 范书铎. 短期禁食对大鼠心肌缺血再灌注心律失常及心肌能量代谢的影响[J]. 中国临床药理学与治疗学, 2009, 14(8): 900-905.
[14]	谢明星, 王新房, 朱向明, 杨娅, 吕清, 陈立新, 聂绍平, 蒋桔泉, 曹林生. 急性心肌缺血激光心肌血管重建术与碱性成纤维生长因子联合应用对心脏功能及心肌存活性影响的实验研究¹[J]. 中国临床药理学与治疗学, 2003, 8(2): 149-154.
[15]	方五旺, 阎月英, 段宝祥. 扩张型心肌病大鼠心脏左室内皮素受体及其亚型分析[J]. 中国临床药理学与治疗学, 2001, 6(4): 322-325.