主动脉瓣疾病病因类型及变迁分析

Etiology of Aortic Valve Diseases and Their Temporal Shifts

目的:探讨本地区主动脉瓣病变的病因特征和时代变迁,为主动脉瓣病变的诊治提供依据。方法:回顾分析我院不同时代的主动脉瓣置换术患者的临床资料,分析其病因特征,比较其时代差异。分别以主动脉瓣狭窄、主动脉瓣关闭不全、主动脉瓣狭窄合并关闭不全3组分析,具体病因包括风湿性、二叶式主动脉、退行性主动脉瓣、主动脉根部扩张、感染性心内膜炎、少见及未确定等6类病因。结果:风湿性、二叶式主动脉瓣、主动脉根部扩张以及退行性主动脉瓣病变是主要的病因类型,其中单纯主动脉瓣狭窄以风湿性(43例,占59.7%)及二叶瓣17例(23.6%)病因为主,单纯主动脉瓣关闭不全以根部扩张(38例,占43.2%)为主,主动脉瓣狭窄合并关闭不全则以风湿性(70例,占88.5%)为主。随着社会进步和人口老龄化,风湿性病因所占比例大幅下降,主动脉根部扩张导致的主动脉关闭不全有较大幅度的上升,退行性主动脉瓣有所上升,二叶式主动脉瓣、感染性心内膜炎所致瓣膜损害变化不明显。结论:主动脉瓣病因构成的改变及其特征对主动脉瓣临床诊治和医疗策略制定具有指导意义。

Objective： To investigate the etiology of aortic valve diseases and their temporal shifts. Methods： The clinic data of cases undergone aortic valve replacement in our hospital in year 1986, 1996 and 2006 were retrospectively reviewed. The characteristics and changes of etiology were analyzed. All cases with aortic diseases were divided into single aortic stenosis, single aortic insufficiency, and combined aortic stenosis plus insufficiency group. The causes of acrtic valve diseases in the three groups were analyzed. Results： Rheumatism was the most common reason, accounting for 59. 7% （43 cases） of simple aortic stenosis, while bicuspid valves accounted for 23.6% （17 cases）. The most common cause for aortic insufficiency was root dilation（38 patients, 43.2%）. And rheumatic valves also accounted for 70 cases （88.5%） of aortic stenosis plus insufficiency. The rheumatic valves was decreased dramatically as the cause of the aortic valve disease, aortic root dilation and degenerative valves increased significantly, while others had no significant changes. Conclusion： The recent changes of etiology and characteristics of aortic valve disease for doctors in the clinical practice.