中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2014年
12期
1029-1034
,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%副神经节瘤%心脏扩大
嗜鉻細胞瘤%副神經節瘤%心髒擴大
기락세포류%부신경절류%심장확대
Pheochromocytoma%Paraganglioma%Cardiomegaly
目的 探究嗜铬细胞瘤与副神经节瘤(PH/PGL)患者左心室肥厚的临床意义.方法 入选2010年10月至2013年4月就诊于北京协和医院的PH/PGL患者78例作为PH/PGL组,以无高血压、血糖异常、血脂异常病史,且X线胸片、心电图、超声心动图检查正常的健康者46例作为对照组.记录和分析患者的症状、体征、24h尿儿茶酚胺水平、心电图和超声心动图检查结果.结果 (1) PH/PGL组患者的左心室射血分数、心指数、左心室质量指数、左心房容积指数、二尖瓣血流舒张早期峰值流速(E)/二尖瓣环舒张早期峰值速度(E ')均高于对照组(P均＜0.01),二尖瓣环侧壁侧E’低于对照组(P=0.012).(2)左心室肥厚PH/PGL患者病程中发生急性左心功能衰竭[12％(3/25)比0,P=0.030]、左心室射血分数持续下降[12％ (3/25)比0,P=0.030]、心电图ST-T段改变[60％ (15/25)比21％(11/53),P=0.0m]比例高于无左心室肥厚PH/PGL患者,左心房容积指数[(30.2±8.8) ml/m2比(23.8 ±4.7)ml/m2,P =0.007]、二尖瓣E/E’(11.2±6.0比7.2±1.4,P=0.003)高于无左心室肥厚PH/PGL患者,二尖瓣环间隔侧E’峰[(7.8±2.6)cm/s比(10.4±3.2)cm/s,P=0.001]与侧壁侧E '峰[(9.3±3.3)cm/s比(12.9±2.9)cm/s,P＜0.001]、平均收缩峰[(7.9±1.6) cm/s比(8.8±1.7) cm/s,p=0.036]低于无左心室肥厚PH/PGL患者.(3)多元线性回归分析显示,年龄(t=3.491,P=0.001)、性别(t=2.899,P=0.005)、心率(t=2.255,P=0.027)、24 h尿去甲肾上腺素(t=3.369,P=0.001)为PH/PGL患者左心室质量指数的独立影响因素.结论 PH/PGL患者左心室肥厚与急性左心功能衰竭、左心室舒张功能障碍和左心室充盈压升高有关.
目的 探究嗜鉻細胞瘤與副神經節瘤(PH/PGL)患者左心室肥厚的臨床意義.方法 入選2010年10月至2013年4月就診于北京協和醫院的PH/PGL患者78例作為PH/PGL組,以無高血壓、血糖異常、血脂異常病史,且X線胸片、心電圖、超聲心動圖檢查正常的健康者46例作為對照組.記錄和分析患者的癥狀、體徵、24h尿兒茶酚胺水平、心電圖和超聲心動圖檢查結果.結果 (1) PH/PGL組患者的左心室射血分數、心指數、左心室質量指數、左心房容積指數、二尖瓣血流舒張早期峰值流速(E)/二尖瓣環舒張早期峰值速度(E ')均高于對照組(P均＜0.01),二尖瓣環側壁側E’低于對照組(P=0.012).(2)左心室肥厚PH/PGL患者病程中髮生急性左心功能衰竭[12％(3/25)比0,P=0.030]、左心室射血分數持續下降[12％ (3/25)比0,P=0.030]、心電圖ST-T段改變[60％ (15/25)比21％(11/53),P=0.0m]比例高于無左心室肥厚PH/PGL患者,左心房容積指數[(30.2±8.8) ml/m2比(23.8 ±4.7)ml/m2,P =0.007]、二尖瓣E/E’(11.2±6.0比7.2±1.4,P=0.003)高于無左心室肥厚PH/PGL患者,二尖瓣環間隔側E’峰[(7.8±2.6)cm/s比(10.4±3.2)cm/s,P=0.001]與側壁側E '峰[(9.3±3.3)cm/s比(12.9±2.9)cm/s,P＜0.001]、平均收縮峰[(7.9±1.6) cm/s比(8.8±1.7) cm/s,p=0.036]低于無左心室肥厚PH/PGL患者.(3)多元線性迴歸分析顯示,年齡(t=3.491,P=0.001)、性彆(t=2.899,P=0.005)、心率(t=2.255,P=0.027)、24 h尿去甲腎上腺素(t=3.369,P=0.001)為PH/PGL患者左心室質量指數的獨立影響因素.結論 PH/PGL患者左心室肥厚與急性左心功能衰竭、左心室舒張功能障礙和左心室充盈壓升高有關.
목적 탐구기락세포류여부신경절류(PH/PGL)환자좌심실비후적림상의의.방법 입선2010년10월지2013년4월취진우북경협화의원적PH/PGL환자78례작위PH/PGL조,이무고혈압、혈당이상、혈지이상병사,차X선흉편、심전도、초성심동도검사정상적건강자46례작위대조조.기록화분석환자적증상、체정、24h뇨인다분알수평、심전도화초성심동도검사결과.결과 (1) PH/PGL조환자적좌심실사혈분수、심지수、좌심실질량지수、좌심방용적지수、이첨판혈류서장조기봉치류속(E)/이첨판배서장조기봉치속도(E ')균고우대조조(P균＜0.01),이첨판배측벽측E’저우대조조(P=0.012).(2)좌심실비후PH/PGL환자병정중발생급성좌심공능쇠갈[12％(3/25)비0,P=0.030]、좌심실사혈분수지속하강[12％ (3/25)비0,P=0.030]、심전도ST-T단개변[60％ (15/25)비21％(11/53),P=0.0m]비례고우무좌심실비후PH/PGL환자,좌심방용적지수[(30.2±8.8) ml/m2비(23.8 ±4.7)ml/m2,P =0.007]、이첨판E/E’(11.2±6.0비7.2±1.4,P=0.003)고우무좌심실비후PH/PGL환자,이첨판배간격측E’봉[(7.8±2.6)cm/s비(10.4±3.2)cm/s,P=0.001]여측벽측E '봉[(9.3±3.3)cm/s비(12.9±2.9)cm/s,P＜0.001]、평균수축봉[(7.9±1.6) cm/s비(8.8±1.7) cm/s,p=0.036]저우무좌심실비후PH/PGL환자.(3)다원선성회귀분석현시,년령(t=3.491,P=0.001)、성별(t=2.899,P=0.005)、심솔(t=2.255,P=0.027)、24 h뇨거갑신상선소(t=3.369,P=0.001)위PH/PGL환자좌심실질량지수적독립영향인소.결론 PH/PGL환자좌심실비후여급성좌심공능쇠갈、좌심실서장공능장애화좌심실충영압승고유관.
Objective To explore the clinical implications of left ventricular hypertrophy (LVH) in patients with pheochromocytoma and paraganglioma(PH/PGL).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.Forty-six healthy people who had no hypertension,pathoglycemia,dyslipidemia history,and with normal chest X-ray,electrocardiogram and echocardiography results served as control group.Clinical symptoms and signs,levels of 24-hour urinary catecholamine,electrocardiogram and echocardiography of participants were recorded and analyzed.Results (1) Left ventricular ejection fraction,cardiac output index,left ventricular mass index (LVMI),left atrial volume index (LAVI) and mitral E/E' were all significantly higher while mitral annulus lateral E' velocity was significantly lower in PH/PGL group than in control group(all P ＜ 0.05).(2) LVH was associated with more prevalent acute left-sided heart failure episodes (12％ (3/25)vs.0,P =0.030),sustained LVEF depression (12％ (3/25) vs.0,P =0.030) and ECG ST-T segment alterations (60％ (15/25) vs.21％ (11/53),P =0.001) in PH/PGL patients.LAVI ((30.2 ± 8.8) ml/m2 vs.(23.8 ± 4.7) ml/m2,P =0.007) and mitral E/E' (11.2 ± 6.0 vs.7.2 ± 1.4,P =0.003) were significantly higher in patients with LVH than in patients without LVH.Mitral annulus septal ((7.8 ± 2.6) cm/s vs.(10.4 ± 3.2) cm/s,P =0.001) and lateral ((9.3±3.3) cm/s vs.(12.9±2.9)cm/s,P＜0.001) E' velocity,averaged S' velocity((7.9 ± 1.6) cm/s vs.(8.8 ± 1.7) cm/s,P =0.036) were significantly lower in LVH patients comparing to patients without LVH.(3) According to multiple linear regression analysis,age (t =3.491,P =0.001),gender (t =2.899,P =0.005),heart rate (t =2.255,P =0.027),and 24-hour urinary norepinephrine level (t =3.369,P =0.001) were independent factors affecting LVMI of PH/PGL patients.Conclusion Left ventricular hypertrophy is associated with acute left-sided heart failure,left ventricular diastolic dysfunction and elevated left ventricular filling pressure in PH/PGL patients.
