摘要
目的:总结二尖瓣反流(Mitral Regurgitation,MR)住院患者的主要临床特征及治疗选择因素分析。方法:连续入选2014-01-01至2015-12-31入住阜外医院,经胸超声心动图检查确诊为中度及中度以上MR的患者3 450例。根据治疗方式的不同,将所有入选患者分为手术组(n=1 845)和药物组(n=1 605)。采集患者入院时的基线资料及经胸超声心动图信息,比较不同治疗方式的两组患者临床特征之间的差异并分析决定治疗方式的影响因素。结果:3 450例患者平均年龄为(54.8±13.8)岁,≥65岁的老龄患者占总人数的26.99%(931例)。原发性病因是MR患者最多见的病因类型,就诊时无症状的患者为324例(9.39%),1 907例(55.28%)患者左心室射血分数(LVEF)下降。1 605例(46.52%)的患者未行手术治疗而采用药物保守治疗。3 450例患者住院期间总死亡率为0.75%(26例)。与药物组相比,手术组患者平均年龄较小[(52.65±12.01)岁vs(57.39±15.25)岁,P<0.001)],重度反流患者比例(56.69%vs 26.79%,P<0.001)、原发MR患者比例(89.49%vs 39.00%,P<0.001)、LVEF平均值[(61.62±9.20)%vs(48.00±17.53)%,P<0.001]均较药物组更高。Logistic回归分析显示,影响中重度MR患者治疗方式选择的因素主要有年龄(OR=0.561,95%CI:0.503~0.627)、MR病因类型(OR=3.062,95%CI:2.565~3.654)、MR程度(OR=0.103,95%CI:0.085~0.126)、LVEF(OR=2.478,95%CI:2.147~2.860)。结论:3 450例中重度MR患者中,老年患者占相当一部分比例,主要病因是原发性二尖瓣病变。高达46.52%的患者只接受药物保守治疗而未能进行外科干预。年龄增加、继发性病因、中度病变、LVEF减低是中重度MR患者接受药物保守治疗的主要影响因素。
Objectives： To observe the clinical features and factorsrelated to treatment decision for hospitalizedpatients with mitral regurgitation（MR）.Methods： A total of 3 450 consecutivepatients with transthoracic echocardiography（TTE） confirmed moderate to severe MR admitted in our hospital from 2014-01-01 to 2015-12-31 were enrolled. Base on therapeutic method, the patients were divided into 2 groups： Surgery group, n=1 845 and Medication group, n=1 605. The baseline data including TTE results were collected, clinical features were compared between 2 groups and factors related to treatment decision were analyzed.Results： Mean age of this patient cohort was（54.8±13.8） years including 26.99%（931/3 450） patients aged ≥ 65 years. The most common etiology was primary MR, 324（9.39%） patients were asymptomatic at admission and decreased left ventricular ejection fraction（LVEF） was evidenced in 55.28%（1 907） patients. Total in-hospital mortality was 0.75%（26）. Compared with Medication group, the patients in Surgery group were younger（[52.65±12.01] years vs [57.39±15.25] years）, prevalence of severe MR（56.69% vs 26.79%） and primary MR（89.49% vs 39.00%）, as well as LVEF value（[61.62±9.20] % vs [48.00±17.53] %） werehigher（all P〈0.001）.Logistic regression analysis indicated that age（OR=0.561, 95% CI 0.503-0.627）, MR etiology（OR=3.062, 95% CI 2.565-3.654）, MR grade（OR=0.103, 95% CI 0.085-0.126） and LVEF（OR=2.478, 95% CI 2.147-2.860） were the determinants for treatmentdecision making in hospitalized patients with moderate to severe MR.Conclusions：In this patient cohort, there are considerable proportion of aged patients with moderate to severe MR. Primary MRis the major etiology. 46.52% patients received conservative therpay instead of surgery, older age,secondary MR, moderate MR and decreased LVEF are the major reasons for choosing conservative therapy in this patient cohort.
作者
诸葛瑞琪
张明子
侯晓沛
赵振燕
吴永健
ZHUGE Rui-qi;ZHANG Ming-zi;HOU Xiao-pei;ZHAO Zhen-yan;WU Yong-jian(Department of Cardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, CAMS and PUMC, Beijing （100037）, China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第6期606-610,共5页
Chinese Circulation Journal
关键词
二尖瓣闭锁不全
疾病特征
临床方案
Mitral valve insufficiency
Diseasefeatures
Clinical therapeutic strategies
