摘要
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.
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.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2014年第12期1029-1034,共6页
Chinese Journal of Cardiology
