射血分数正常心力衰竭与心脏重构关系的研究
사혈분수정상심력쇠갈여심장중구관계적연구
Relations between heart failure with normal ejection fraction and cardiac remodeling
  • 万方数据
    中国综合临床 중국종합림상
    CLINICAL MEDICINE OF CHINA
    2013年 1期 38-41 ,共4页

    韩振%姜毅%孙雪林

    한진%강의%손설림

    心力衰竭%射血分数%心脏重构 心力衰竭%射血分數%心髒重構
    심력쇠갈%사혈분수%심장중구
    Heart failure%Ejection fraction%Cardiac remodeling
    目的 探讨射血分数正常心力衰竭与心脏重构的关系.方法 收集2009年1月至2012年3月龙口市人民医院心内科收治的慢性心力衰竭患者188例,严格依照诊断标准分为射血分数正常心力衰竭109例(HFNEF组)与射血分数下降心力衰竭79例(HFREF组),并按NYHA分级不同又各自分为3个亚组(HFNEF组:心功能Ⅱ级组52例、心功能Ⅲ级组36例、心功能Ⅳ级组21例；HFREF组:心功能Ⅱ级组13例,心功能Ⅲ级组27例,心功能Ⅳ级组39例),测量所有纳入对象的左心室射血分数(LVEF)、左心房内径(LAD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、右心室内径(RVD)等,并对其临床资料进行统计学分析.结果 HFNEF组较HFREF组年龄大[(64.59 ±5.34)岁与(58.89±4.23)岁,t=3.345,P=0.001]、女性患者多[58.7％(64/109)与41.8(33/79),x2=5.265,P=0.022)]、高血压比例高[81.65％(89/109)与63.29％(50/79),x2=8.012,P=0.005].不同心功能分级的HFNEF患者随着心功能下降严重程度的增加,其LVPWT、IVST、LAD、RVD均表现为逐渐增大,但在LVPWT[(9.05±1.89)、(11.30±2.67)、(13.90±2.77) mm,F=3.578,P ＜0.05]、IVST[(9.35±1.75)、(11.51±2.48)、(12.98±3.01) mm,F=3.081,P＜ 0.05]、LAD[(31.23 ±5.98)、(35.55±7.31)、(44.81±10.72)mm,F=6.711,P＜0.001]方面差异有统计学意义,在RVD [(18.95±1.02)、(19.21±1.11)、(19.99±0.98) mm)中差异无统计学意义(F=2.751,P＞0.05].心功能Ⅳ级的HFNEF与HFREF患者在LVPWT[(13.90±2.77)、(7.45±2.01)mm,t=11.439,P＜0.001]、IVST[(12.98±3.01)mm与(7.23±1.94) mm,t=10.318,P＜0.001]、RVD[(19.99±0.98) mm与(23.51±1.10)mm,t=2.838,P＜0.01]方面差异有统计学意义,而LAD [(44.81±10.72)mm与(46.30±11.76) mm]比较差异无统计学意义(=1.451,P＞0.05).结论 HFNEF患者中高龄、女性、高血压患者比例高,并对心脏重构的影响表现为随心功能分级的加重而加大,但对右心室几乎无影响,其心室结构变化与HFREF存在明显不同.因此临床医师须深入认识HFNEF的流行病学、病理生理学特点、诊断标准及治疗原则,从而更好地对该类患者进行诊断与治疗.
    목적 탐토사혈분수정상심력쇠갈여심장중구적관계.방법 수집2009년1월지2012년3월룡구시인민의원심내과수치적만성심력쇠갈환자188례,엄격의조진단표준분위사혈분수정상심력쇠갈109례(HFNEF조)여사혈분수하강심력쇠갈79례(HFREF조),병안NYHA분급불동우각자분위3개아조(HFNEF조:심공능Ⅱ급조52례、심공능Ⅲ급조36례、심공능Ⅳ급조21례；HFREF조:심공능Ⅱ급조13례,심공능Ⅲ급조27례,심공능Ⅳ급조39례),측량소유납입대상적좌심실사혈분수(LVEF)、좌심방내경(LAD)、실간격후도(IVST)、좌심실후벽후도(LVPWT)、우심실내경(RVD)등,병대기림상자료진행통계학분석.결과 HFNEF조교HFREF조년령대[(64.59 ±5.34)세여(58.89±4.23)세,t=3.345,P=0.001]、녀성환자다[58.7％(64/109)여41.8(33/79),x2=5.265,P=0.022)]、고혈압비례고[81.65％(89/109)여63.29％(50/79),x2=8.012,P=0.005].불동심공능분급적HFNEF환자수착심공능하강엄중정도적증가,기LVPWT、IVST、LAD、RVD균표현위축점증대,단재LVPWT[(9.05±1.89)、(11.30±2.67)、(13.90±2.77) mm,F=3.578,P ＜0.05]、IVST[(9.35±1.75)、(11.51±2.48)、(12.98±3.01) mm,F=3.081,P＜ 0.05]、LAD[(31.23 ±5.98)、(35.55±7.31)、(44.81±10.72)mm,F=6.711,P＜0.001]방면차이유통계학의의,재RVD [(18.95±1.02)、(19.21±1.11)、(19.99±0.98) mm)중차이무통계학의의(F=2.751,P＞0.05].심공능Ⅳ급적HFNEF여HFREF환자재LVPWT[(13.90±2.77)、(7.45±2.01)mm,t=11.439,P＜0.001]、IVST[(12.98±3.01)mm여(7.23±1.94) mm,t=10.318,P＜0.001]、RVD[(19.99±0.98) mm여(23.51±1.10)mm,t=2.838,P＜0.01]방면차이유통계학의의,이LAD [(44.81±10.72)mm여(46.30±11.76) mm]비교차이무통계학의의(=1.451,P＞0.05).결론 HFNEF환자중고령、녀성、고혈압환자비례고,병대심장중구적영향표현위수심공능분급적가중이가대,단대우심실궤호무영향,기심실결구변화여HFREF존재명현불동.인차림상의사수심입인식HFNEF적류행병학、병리생이학특점、진단표준급치료원칙,종이경호지대해류환자진행진단여치료.
    Objective To investigate the relationship between heart failure with normal ejection fraction and cardiac remodeling.Methods One hundred and eighty-eight cases with chronic heart failure were collected from January 2009 to March 2012 from Department of Cardiology of Longkou People's Hospital.In strictly accordance with the diagnostic criteria,participants were divided into HFNEF(n =109) and HFREF groups (n =79).According to the NYHA classification,HFNEF and HFREF patients were further divided into three subgroups respectively (HFNEF patients:52 cardiac function Ⅱ,36 cardiac function Ⅲ,21 cardiac function Ⅳ ;HFREF patients:13 cardiac function Ⅱ,27 cardiac functionⅢ,39 cardiac functionⅣ).The measurements of the left ventricular ejection fraction (LVEF),left atrial diameter (LAD),interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),right ventricular diameter (RVD) were conducted in all objects and their clinical data were statistically analyzed.Results Compared with HFREF patients,HFNEF group had older mean age ((64.59 ± 5.34) yrs vs.(58.89 ± 4.23) yrs,t =3.345,P =0.001),more female patients (58.7％ (64/109) vs.41.8％ (33/79),x2 =5.265,P =0.022),higher incidence of hypertension (81.65％ (89/109) vs.63.29％ (50/79),x2 =8.012,P =0.005).LVPWT,IVST,LAD,RVD gradually increased in HFNEF patients with the severity of cardiac function,with significant differences in LVPWT ((9.05 ± 1.89) mm vs.(11.30 ± 2.67) mm vs.(13.90 ± 2.77) mm,F =3.578,P =0.028),IVST ((9.35 ±1.75)mm vs.(11.51 ±2.48)mm vs.(12.98 ±3.01)mm,F =3.081,P =0.048),LAD ((31.23 ±5.98)mm vs.(35.55 ±7.31)mm vs.(44.81 ± 10.72)mm,F =6.711,P ＜0.001),but no difference in RVD ((18.95 ±1.02) mm vs.(19.21 ± 1.11) mm vs.(19.99 ± 0.98) mm,F =2.751,P ＞ 0.05).There was significant difference in LVPWT ((13.90 ±2.77)mm vs.(7.45 ±2.01)mm,t =11.439,P ＜0.001),IVST ((12.98 ±3.01)mm vs.(7.23 ± 1.94)mm,t =10.318,P ＜0.001),RVD ((19.99 ±0.98)mm vs.(23.51 ± 1.10)mm,t =2.838,P ＜ 0.001) between HFNEF and HFREF patients with Ⅳ level of cardiac function,while there was no statistical difference ((44.81 ± 10.72) nn vs.(46.30 ± 11.76) mm),t =1.451,P =0.151) on LAD.Conclusion Senior age,high proportions of women and essential hypertension are found in HFNEF patients.Impaired cardiac function has increasing impact on cardiac remodeling with the increase of severity but it almost has no effect on the right ventricle.Ventricular structural changes exist significantly different from HFNEF to HFREF.Therefore clinicians should have in-depth understanding of the characteristics of the HFNEF and its epidemiology,pathophysiology,diagnostic criteria and treatment principles in order to improve diagnosis and treatment of this class of patients.
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