经皮球囊二尖瓣成形术疗效和术后左心房重构的可控影响因素

Outcome and factors affecting left atrial remodeling after percutaneous balloon mitral valvuloplastyin patients with mitral valve stenosis

目的 探讨经皮球囊二尖瓣成形术（PBMV）治疗二尖瓣狭窄的疗效和术后左心房重构的可控影响因素.方法 选取我院1998年3月至2002年6月行PBMV的二尖瓣狭窄患者96 例.收集术前、术后1周和术后4～6年超声心动图、12导联心电图等临床资料进行回顾性分析.采用多元逐步回归方法分析影响术后左心房重构的可控临床因素.结果 PBMV术前左心房内径与术后1周比较差异无统计学意义[（44.6±6.6）cm比（42.8±6.5）cm,P〉0.05];术后4～6年左心房内径为（47.2±5.7）cm,均大于术前和术后1周（P均〈0.05）.与术前比较,术后1周和4～6年二尖瓣口面积均较大[（2.02±0.43）cm2和（1.98±0.36）cm2比（1.06±0.32）cm2,P均〈0.05].术后1周和术后4～6年心功能Ⅰ和Ⅱ级（纽约心脏病学会分级）患者比例均高于术前（P〈0.01）.多元回归分析显示,与术后4～6年左心房内径相关的可控因素包括术后4～6年收缩压水平、术后1周二尖瓣口面积、术前心房颤动、术前Wilkins积分≤8分,术前左心房内径（P均〈0.05）.结论 PBMV治疗二尖瓣狭窄的近期效果明显.术后4～6年收缩压水平、术后1周二尖瓣口面积、术前心房颤动、术前Wilkins积分≤8分。

Objective To observe the outcome and assess related factors affecting left atrial remodeling after percutaneous balloon mitral valvuloplasty （PBMV） in patients with mitral valve stenosis. Methods From March 1998 to June 2002,there were 96 mitral valve stenosis patients who underwent PBMV in our hospital. Echocardiographic,12 leads united electrocardiogram and other clinical datas were collected at preoperation,1 week after operation,and 4-6 years after operation to retrospectiveanalysis. Multiple stepwise regression analysis was used to assess controllable factors of left atrial remodeling. ResultsLeft atrial diameter reduced from （44.6±6.6）cm before PBMV to （42.8±6.5）cm （P〉0.05） 1 week after PBMV and enlarged to （47.2±5.7）cm （all P〈0.05） at the end of 4-6 years follow up post operation. The mitral valve area （MVA） increased from （1.06±0.32） cm2 before PBMV to （2.02±0.43） cm2 1 week after PBMV and （1.98±0.36）cm2 4-6 years post operation （all P〈0.05）. Heart function assessed by NYHA classification improved significantly at 1 week and 4-6 years after surgery compared with pre-operation（P〈0.01）. Multiple stepwise regression analysis showed that systolic blood pressure at 4-6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins score≤8, preoperative left atrial diameter were the independent predictive factors of left atrial remodeling at 4-6 years after PBMV.Conclusions PBMV was an effective therapy option for patients with mitral valve stenosis.Systolic blood pressure at 4-6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins≤8, preoperative left atrial diameter are the predictive factors of left atrial remodeling after PBMV