CAJ | 학술논문

目的对肥厚型心肌病患者临床特征及其受累肥厚节段的分布和程度进行分析.方法连续收集2004年3月至2007年3月225例临床诊断或可疑的肥厚型心脏病患者的临床资料,包括症状、体征、心电图检查及超声心动图检查等.所有患者均接受心脏核磁共振检查.依据9节段分析法分析受累节段范围、程度等.结果肥厚型心肌病患者中男163例,女62例,平均年龄(50.4±14.5)岁.28例肥厚型心肌病患者临床无症状,系通过体检发现.197例肥厚型心肌病患者临床症状明显,其中11例伴发晕厥.216例肥厚型心肌病患者心电图异常,73例患者有明确家族史.126例肥厚型心肌病患者可闻及收缩期杂音.超声心动图发现95例患者合并左心室流出道梗阻,32例患者伴发二尖瓣关闭不全.肥厚型心肌病患者合并高血压50例,合并冠心病14例,合并糖尿病5例.225例患者左心房前后径平均为(39.4±8.3)mm,左心室舒张末期横径平均为(47.8±5.5)mm.依据9节段分析法,32.1%的节段受累.非对称性肥厚患者222例,其中室间隔受累198例,对称性肥厚患者3例.心尖受累67例,其中单独心尖受累24例.98例患者室间隔和左心室前壁同时受累.所有室间隔肥厚患者室间隔平均厚度为(23.0±5.2)mm.其中伴发左心室流出道梗阻患者室间隔平均厚度为(24.3±5.3)mm,高于无梗阻患者(21.6±4.6)mm,P＜0.05.所有心尖肥厚患者心尖平均厚度为(15.6±3.4)mm.结论我国肥厚型心肌病患者男性比例较高,临床发病时间较晚.心脏磁共振能很好地评估肥厚型心肌病各个亚型的病理解剖学特征,是准确诊断肥厚型心肌病的有效方法.
목적 대비후형심기병환자림상특정급기수루비후절단적분포화정도진행분석.방법 련속수집2004년3월지2007년3월225례림상진단혹가의적비후형심장병환자적림상자료,포괄증상、체정、심전도검사급초성심동도검사등.소유환자균접수심장핵자공진검사.의거9절단분석법분석수루절단범위、정도등.결과 비후형심기병환자중남163례,녀62례,평균년령(50.4±14.5)세.28례비후형심기병환자림상무증상,계통과체검발현.197례비후형심기병환자림상증상명현,기중11례반발훈궐.216례비후형심기병환자심전도이상,73례환자유명학가족사.126례비후형심기병환자가문급수축기잡음.초성심동도발현95례환자합병좌심실류출도경조,32례환자반발이첨판관폐불전.비후형심기병환자합병고혈압50례,합병관심병14례,합병당뇨병5례.225례환자좌심방전후경평균위(39.4±8.3)mm,좌심실서장말기횡경평균위(47.8±5.5)mm.의거9절단분석법,32.1%적절단수루.비대칭성비후환자222례,기중실간격수루198례,대칭성비후환자3례.심첨수루67례,기중단독심첨수루24례.98례환자실간격화좌심실전벽동시수루.소유실간격비후환자실간격평균후도위(23.0±5.2)mm.기중반발좌심실류출도경조환자실간격평균후도위(24.3±5.3)mm,고우무경조환자(21.6±4.6)mm,P＜0.05.소유심첨비후환자심첨평균후도위(15.6±3.4)mm.결론 아국비후형심기병환자남성비례교고,림상발병시간교만.심장자공진능흔호지평고비후형심기병각개아형적병리해부학특정,시준학진단비후형심기병적유효방법.
Objective To analyze the clinical data and hypertrophic segments distribution of patients with hypertrophic cardiomyopathy (HCM). Methods Clinical data including signs and symptoms,electrocardiogram and echocardiography were collected. All patients were imaged with cardiac magnetic resonance imaging (CMR). Results From March 2004 to March 2007, 225 consecutive patients [163males, mean age(50. 4 ± 14. 5 )years] with CMR defined HCM were included in this study, positive familial history was obtained in 73 patients, 50 patients were associated with hypertension, 14 patients with coronary artery disease and 5 patients with diabetes mellitus, 28 patients were asymptomatic, 197 patients were symptomatic, and 11 patients with syncope. Electrocardiogram abnormalities occurred in 216 patients.Systolic murmurs were present in 126 patients. Echocardiography examination evidenced left ventricular outflow obstruction in 95 patients, mitral insufficiency in 32 patients, 32. 1% segments were hypertrophied,asymmetrical hypertrophy presented in 222 patients and symmetrical hypertrophy in 3 patients. The left atrial dimension was( 39. 4 ± 8.3 )mm, and left ventricular diastolic dimension was (47. 8 ± 5.5 )mm in this cohort. Apical hypertrophy occurred in 67 patients. The thickness of ventricular septum was (24. 3 ± 5. 3)mm in obstructive HCM and ( 21.6 ± 4. 6) mm in non-obstructive HCM ( P ＜ 0. 05 ). The thickness of hypertrophy apical segment was ( 15.6 ± 3.4) mm. Conclusions HCM in Chinese patients is characterized by the high prevalenee among men and late onset of presentation. Combining clinical, electrocardiogram,echocardiographic and CMR results are of importance for correctly diagnosing HCM in daily practice.