45例原发性肥厚型心肌病临床资料分析

Clinical analysis of 45 cases with hypertrophic cardiomyopathy

对45例原发性肥厚型心肌病（HCM）的临床、心电图、超声心动图资料和其中16树冠状动脉及左室造影资料进行分析，结果显示患者年龄、病程和临床表现差异较大，ECG检查主要表现为左侧胸前导联T波倒置（71％），S－T段下移（71％），左室肥厚或高电压（44．4％）。超声心动图检查示以室间隔非对称性肥厚为主（93．3％），心脏收缩功能正常甚至超常（左心室射血分数56％～86％平均70．5％±10．5％），而有舒张功能的损害（44．4％病例超声心动图二尖瓣口流速曲线峰值A：E＞1）。7例心尖HCM主要表现为心绞痛，ECG表现类似其他非心尖HCM，但其左室肥厚或高电压发生率更高（P＜0.01），T波倒置更深（P＜0．05），超声心动图必要时结合心导管左室造影可明确诊断。1例兼有心肌肥厚和心脏扩大者，心肌收缩功能减退，临床经过凶险。

To improve the clinical recognition of hypertrophic cardiomyopthy (HCM), the data of clinical finds,ECG and UCG for 45 patients and the data of angiography for 16 of them were analyzed. The results have shown the age, clinical course and presentation of the patients were variable. Abnormal findings in ECG mainly included negative T wave (71%), S-T segment deviation (71%) in left precardial leads and LV hypertrophy or high voltage (44. 4%). UCG finding of asymmetric septal hypertrophy was mainly feature (93. 3%). There was normal or supernormal LV systolic function (LVEF: 70. 5%± 10. 5% ) but abnormal diastolic function (UCG:A peak ＞E peak n = 15). Of 45 patients above, 7 patients with apical HCM manifested more angina pectoris (71. 4% ) and gianter negative T wave in left percardial leads (P＜0. 05) and more incidence of LV hypertrophy or high voltage in ECG (P＜0.01 ) than the other patients with HCM did. Noticeably. a patient with LV enlargement and systolic disfunctin as well as LV hypertrophy had dangerous clinical manifestation.