中国心血管杂志
中國心血管雜誌
중국심혈관잡지
CHINESE JOURNAL OF CARDIOVASOLOGY
2014年
4期
246-251
,共6页
丁莉%方理刚%朱文玲%曾正陪%李汉忠
丁莉%方理剛%硃文玲%曾正陪%李漢忠
정리%방리강%주문령%증정배%리한충
嗜铬细胞瘤%心血管表现%高血压%心肌疾病
嗜鉻細胞瘤%心血管錶現%高血壓%心肌疾病
기락세포류%심혈관표현%고혈압%심기질병
Pheochromocytoma%Cardiovascular manifestation%Hypertension%Cardiomyopathies
目的：探究嗜铬细胞瘤/副节瘤( PH/PGL)患者中心血管异常的发生率、表现形式、临床转归与其发生机制。方法入选2010年10月至2013年4月期间就诊于北京协和医院的78例PH/PGL患者,记录患者临床症状、血压、心率、心肌酶、心力衰竭标记物、心电图、超声心动图表现及24 h尿儿茶酚胺水平,并进行分析。结果(1)78例患者中,66例(84.6%)有高血压,3例(3.8%)病程中有低血压病史。45例(57.7%)存在心脏损害,包括急性左心功能不全3例(3.8%),心肌酶与心电图ST-T段动态变化6例(7.7%),左心室射血分数下降6例(7.7%),其中5例随访恢复正常,心律失常30例(38.5%),左心室肥厚25例(32.1%)。(2)以有无左心室肥厚将高血压PH/PGL患者分为两组,两组高血压病程、表现为持续与阵发性血压升高比例、血压水平差异无统计学意义,肥厚组24 h尿去甲肾上腺素[435(61~766)μg/24 h比110(35~242)μg/24 h,U=320,P﹤0.01]、肾上腺素[3.51(3.01~4.53)μg/24 h比2.88(2.32~3.89)μg/24 h,U=337,P=0.02]显著高于无肥厚组。结论 PH/PGL可引起多种心血管损害,少数出现左心室射血分数下降,大多可逆。
目的：探究嗜鉻細胞瘤/副節瘤( PH/PGL)患者中心血管異常的髮生率、錶現形式、臨床轉歸與其髮生機製。方法入選2010年10月至2013年4月期間就診于北京協和醫院的78例PH/PGL患者,記錄患者臨床癥狀、血壓、心率、心肌酶、心力衰竭標記物、心電圖、超聲心動圖錶現及24 h尿兒茶酚胺水平,併進行分析。結果(1)78例患者中,66例(84.6%)有高血壓,3例(3.8%)病程中有低血壓病史。45例(57.7%)存在心髒損害,包括急性左心功能不全3例(3.8%),心肌酶與心電圖ST-T段動態變化6例(7.7%),左心室射血分數下降6例(7.7%),其中5例隨訪恢複正常,心律失常30例(38.5%),左心室肥厚25例(32.1%)。(2)以有無左心室肥厚將高血壓PH/PGL患者分為兩組,兩組高血壓病程、錶現為持續與陣髮性血壓升高比例、血壓水平差異無統計學意義,肥厚組24 h尿去甲腎上腺素[435(61~766)μg/24 h比110(35~242)μg/24 h,U=320,P﹤0.01]、腎上腺素[3.51(3.01~4.53)μg/24 h比2.88(2.32~3.89)μg/24 h,U=337,P=0.02]顯著高于無肥厚組。結論 PH/PGL可引起多種心血管損害,少數齣現左心室射血分數下降,大多可逆。
목적：탐구기락세포류/부절류( PH/PGL)환자중심혈관이상적발생솔、표현형식、림상전귀여기발생궤제。방법입선2010년10월지2013년4월기간취진우북경협화의원적78례PH/PGL환자,기록환자림상증상、혈압、심솔、심기매、심력쇠갈표기물、심전도、초성심동도표현급24 h뇨인다분알수평,병진행분석。결과(1)78례환자중,66례(84.6%)유고혈압,3례(3.8%)병정중유저혈압병사。45례(57.7%)존재심장손해,포괄급성좌심공능불전3례(3.8%),심기매여심전도ST-T단동태변화6례(7.7%),좌심실사혈분수하강6례(7.7%),기중5례수방회복정상,심률실상30례(38.5%),좌심실비후25례(32.1%)。(2)이유무좌심실비후장고혈압PH/PGL환자분위량조,량조고혈압병정、표현위지속여진발성혈압승고비례、혈압수평차이무통계학의의,비후조24 h뇨거갑신상선소[435(61~766)μg/24 h비110(35~242)μg/24 h,U=320,P﹤0.01]、신상선소[3.51(3.01~4.53)μg/24 h비2.88(2.32~3.89)μg/24 h,U=337,P=0.02]현저고우무비후조。결론 PH/PGL가인기다충심혈관손해,소수출현좌심실사혈분수하강,대다가역。
Objective To explore the prevalence, manifestations, clinical outcomes and etiology of cardiovascular abnormalities among pheochromocytoma/paraganglioma ( PH/PGL ) patients. Methods Seventy-eight PH/PGL patients receiving medical attention at Peking Union Medical College Hospital from October 2010 to April 2013 were included in the study. Clinical symptoms, blood pressure, heart rate, biomarkers of myocardial injury and heart failure, electrocardiogram, echocardiography, and levels of 24-hour urinary catecholamine of the patients were recorded and analyzed. Results (1) Of the 78 patients, 66 (84. 6%) were hypertensive, 3 ( 3. 8%) experienced hypotensive episodes, 45 ( 57. 7%) had histories indicative of cardiac injuries, including 3 ( 3. 8%) with acute left-sided heart failure episodes, 6 ( 7. 7%) with concurrent evolving cardiac enzyme elevation and alteration of ECG ST-T segment, 6 ( 7. 7%) with decreased left ventricular ejection fraction(LVEF), 5 of which restored during follow-up, 30(38. 5%) with arrhythmias, 25 ( 32. 1%) with left ventricular hypertrophy. ( 2 ) Among hypertensive PH/PGL patients, levels of 24-hour urinary norepinephrine [435(61-766)μg/24 h vs. 110(35-242)μg/24h,U =320,P ﹤0. 01] and epinephrine[3. 51(3. 01-4. 53)μg/24 h vs. 2. 88(2. 32-3. 89)μg/24h,U=337,P=0. 02] were significantly higher in LV hypertrophy group than in normal geometry group, while the duration, manifestation ( sustained vs. paroxysmal) and degree of blood pressure elevation did not differ between the two groups. Conclusions PH/PGL can cause multiple cardiovascular alterations. Decreased LVEF, often reversible, occurs occasionally.
