射血分数正常心力衰竭与心脏重构关系的研究

Relations between heart failure with normal ejection fraction and cardiac remodeling

目的探讨射血分数正常心力衰竭与心脏重构的关系。方法收集2009年1月至2012年3月龙口市人民医院心内科收治的慢性心力衰竭患者188例，严格依照诊断标准分为射血分数正常心力衰竭109例（HFNEF组）与射血分数下降心力衰竭79例（HFREF组），并按NYHA分级不同又各自分为3个亚组（HFNEF组：心功能Ⅱ级组52例、心功能Ⅲ级组36例、心功能Ⅳ级组21例；HFREF组：心功能Ⅱ级组13例，心功能Ⅲ级组27例，心功能Ⅳ级组39例），测量所有纳入对象的左心室射血分数（LVEF）、左心房内径（LAD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、右心室内径（RVD）等，并对其临床资料进行统计学分析。结果HFNEF组较HFREF组年龄大[（64．59±5．34）岁与（58．89±4．23）岁，t=3．345，P=0．001]、女性患者多[58．7％（64／109）与41．8（33／79），X^2=5．265，P=0．022）]、高血压比例高[81．65％（89／109）与63．29％（50／79），X^2=8．012，P=0．005]。不同心功能分级的HFNEF患者随着心功能下降严重程度的增加，其LVPWT、IVST、LAD、RVD均表现为逐渐增大，但在LVPWT[（9．05±1．89）、（11．30±2．67）、（13．90±2．77）mm，F=3．578，P〈0．05]、IVST[（9．35±1．75）、（11．51±2．48）、（12．98±3．01）mm，F=3．081，P〈0．05]、LAD[（31．23±5．98）、（35．55±7．31）、（44．81±10．72）mm，F=6．711，P〈0．001]方面差异有统计学意义，在RVD[（18．95±1．02）、（19．21±1．11）、（19．99±0．98）mm）中差异无统计学意义（F=2．751，P〉0．05]。心功能Ⅳ级的HFNEF与HFREF患者在LVPWT[（13．90±2．77）、（7．45±2．01）mm，t=11．439，P〈0．001]、IVST[（12．98±3．01）mm与（7．23±1．94）mm，t=10．318，P〈0．001]、RVD[（19．99±0．98）mm与（23．51±1．10）mm，t=2．838，P〈0．01]方面差异有统计学意义，而LAD[（44．81±10．72）mm与（46．30±11．76）mini比较差异无统计学意义（t=1．451，P〉0．05）。结论HFNEF患者中高龄、女性、高血压患者比例高，并对心脏重构的影响表现为随心功能分级的加重而加大，但对右心室几乎无影响，其心室结构变化与HFREF存在明显不同。因此临床医师须深入认识HFNEF的流行病学、病理生理学特点、诊断标准及治疗原则，从而更好地对该类患者进行诊断与治疗。

Objective To investigate the relationship between heart failure with normal ejection fraction and cardiac remodeling. Methods One hundred and eighty-eight cases with chronic heart failure were collected from January 2009 to March 2012 from Department of Cardiology of Longkou People＇s Hospital. In strictly accordance with the diagnostic criteria, participants were divided into HFNEF（ n = 109） and HFREF groups （n = 79）. According to the NYHA classification, HFNEF and HFREF patients were further divided into three subgroups respectively （ HFNEF patients ： 52 cardiac function Ⅱ, 36 cardiac function Ⅲ, 21 cardiac function Ⅳ ; HFREF patients ：13 cardiac function Ⅱ ,27 cardiac functionm ,39 cardiac functioniV）. The measurements of the left ventricular ejection fraction （LVEF）, left atrial diameter （LAD）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, right ventricular diameter （RVD） were conducted in all objects and their clinical data were statistically analyzed. Results Compared with HFREF patients, HFNEF group had older mean age （ （ 64. 59 ± 5. 34 ） yrs vs. （ 58. 89 ± 4. 23 ） yrs, t = 3. 345, P = 0. 001 ）, more female patients （ 58.7% （ 64/109 ） vs. 41.8% （ 33/79 ）,X^2 = 5. 265, P = 0. 022 ）, higher incidence of hypertension （81.65% （89/109） vs. 63.29% （50/79）, X^2 = 8.012, P = 0.005）. LVPWT, IVST, LAD, RVD gradually increased in HFNEF patients with the severity of cardiac function, with significant differences in LVPWT （ （9.05 ± 1.89） mm vs. （ 11.30 ± 2. 67） mm vs. （ 13.90 ± 2. 77 ） ram, F = 3. 578, P = 0. 028 ）, IVST （ （9. 35 ±1.75）mm vs. （11.51 ±2.48）ram vs. （12. 98 ±3.01 ）mm,F =3. 081 ,P =0. 048） ,LAD （ （31.23 ±5.98）mm vs. （35. 55 ± 7. 31 ）mm vs. （44. 81 ± 10. 72）mm, F = 6. 711, P 〈 0. 001 ）, but no difference in RVD （ （ 18.95 ± 1.02）mm vs. （ 19. 21 ± 1.11 ） mm vs. （ 19. 99 ± 0. 98） mm, F = 2. 751, P 〉 0. 05） . There was significant difference in LVPWT （ （ 13.90 ± 2.77 ） mm vs. （ 7.45 ± 2. 01 ） ram, t = 11. 439, P 〈 0. 001 ）, IVST （ （ 12. 98 ± 3.01）mm vs. （7.23 ±1.94）mm,t = 10.318,P〈0.001）,RVD （（19. 99 ±0.98）mm vs. （23.51 ±1.10）mm, t =2. 838,P 〈0. 001 ） between HFNEF and HFREF patients with Ⅳ level of cardiac function,while there was no statistical difference （（44.81 ± 10.72）mm vs. （46.30 ± 11.76）mm）,t = 1.451,P =0.151） on LAD. Conelttsion Senior age, high proportions of women and essential hypertension are found in HFNEF patients. Impaired cardiac function has increasing impact on cardiac remodeling with the increase of severity but it almost has no effect on the right ventricle. Ventrieular structural changes exist significantly different from HFNEF to HFREF. Therefore clinicians should have in-depth understanding of the characteristics of the HFNEF and its epidemiology, pathophysiology, diagnostic criteria and treatment principles in order to improve diagnosis and treatment of this class of patients.