肥厚性心肌病42例临床分析

Clinical Analysis of 42 Cases with Hypertrophic Cardiomyopathy

目的观察原发性肥厚性心肌病(HCM)的临床特点。方法对42例肥厚性心肌病的临床特点、心电图、超声心动图进行回顾分析。结果该病的临床表现无特异性,多数伴有临床症状;心电图的改变多种多样,以ST-T改变多见,超声心动图的改变具有诊断价值。42例HCM患者室间隔舒张末期厚度IVSTd为(18.33±3.8)mm,左室后壁舒张末期厚度LVPWTd为(10.77±2.95)mm,IVSTd/LVPWTd比值为1.74±0.5,左心室舒张末期内径LVIDd为(45.06±5.85)mm。梗阻性和非梗阻性HCM两组病人的左室射血分数LVEF%正常,但组间比较无统计学意义(P>0.05)。左室后壁收缩期增厚率(LVPW△T%)均值较室间隔收缩期增厚率(IVS△T%)均值为大,梗阻性IVS△T%较非梗阻性更小(P<0.05),梗阻性组IVSTd、IVSTd/LVPWTd比值、二尖瓣A波峰值与非梗阻性相比更大(P<0.05)。E/A比值在梗阻性肥厚性心肌病<1,而在非梗阻性肥厚性心肌病则>1,但组间无统计学意义(P>0.05)。结论超声心动图能很好地识别HCM室壁异常增厚的特征,并能评价心室的收缩和舒张功能,结合临床、心电图以及超声心动图可以对HCM作出准确诊断。

Objective To observe the clinical features of the primary hypertrophic cardiomyopathy （HCM）. Methods Retrospectively analyzing the clinical characteristics, electrocardiogram, echocardiography of HCM. Results HCM has non-specific clinical manifesta- tions with most accompanied by clinical symptoms; ECG changes variously with ST-T changes seen more common; Echocardiography has a diagnostic value. 42 HCM patients： IVSTd （18.33 ± 3.8） ram, LVPWTd （10.77 ± 2.95） mm, IVSTd / LVPWTd （1.74 ± 0.5）, LVIDd （45.06 ± 5.85） mm. LVEF% was normal in obstructive and non-obstructive HCM groups, but the comparison had no statistical significance between the two groups （P〉0.05）. Mean LVPW A T% was more than IVS A T%, but obstructive IVS A T% was smaller than that of non-obstructive （P〈0.05）. IVSTd, 1VSTd / LVPWTd, A-wave peak in obstructive group was much more than those in non-obstructive group （P〈0.05）. E/A was 〈1 in obstructive group, 〉1 in non-obstructive group, but there was no statistical significance between the two groups （P 〉0.05）. Conclusions Echocardiography can well identify abnormal thickening of HCM, and can evaluate ventrieular systolic and diastolic function. Combi- nation of clinical, ECG, and UCG can make accurate diagnosis of HCM.