彩色多普勒超声心动图评估老年退行性主动脉瓣钙化及相关危险因素的临床研究

Clinical study on risk factors correlated with senile degenerative aortic valve calcification by color Doppler echocardiograph

目的探讨彩色多普勒超声心动图对老年退行性主动脉瓣钙化的诊断价值并分析其相关危险因素。方法应用彩色多普勒超声心动图检查110例患主动脉瓣钙化（AVC）患者（研究组）和110例主动脉瓣无钙化者（对照组）的主动脉瓣，伴有主动脉和主动脉瓣钙化的患者均除外先天性和其他后天性瓣膜疾患。观察主动脉瓣的形态，测量主动脉根部的径线，同时探测主动脉收缩期和舒张期的血流峰值并比较2组不同特征以及研究AVC与某些相关危险因素的关系。结果研究组显示因钙化而造成主动脉瓣环前后径及瓣口面积缩小；主动脉窦部前后径扩大和跨瓣压力阶差升高；大动脉及外周动脉粥样硬化（As）及动脉狭窄检出率高于对照组；AS会使脉压差增大，并加重AVC；相关危险因素除年龄外还有高血压病、高脂血症、骨质疏松等疾病。以上结果与对照组相比，均具有统计学意义（P〈0．05）。这些相关疾病的诊断均以If缶床检验结果为准，伴随相关危险因素越多，AVC发生越明显；此外，性别和升主动脉径线2组比较，其差别无统计学意义（P〉0．05）。相关因素中糖尿病与AVC发生率2组比较，其差别无统计学意义（P〉0．05）。结论老年退行性主动脉瓣钙化可造成老年人主动脉瓣及大血管形态异常改变和功能障碍。伴有相关危险因素的老年人，相关因素越多，主动脉瓣及大血管形态异常改变及功能障碍越明显。

Objective To investigate the value of the senile degenerative aortic valve calcification （AVC） and to analyze the correlative risk factors by color Doppler echocardiograph. Methods Aortic valves of 110 cases with AVC （study group） and 110 cases without AVC （control group） were observed by color Doppler echocardio- graph. All the patients with AVC have been excluded of congenital and other acquired valves＇ diseases. The aortic valve＇ s shape and the diameters of aortic root were measured. At the same time, the peak systolic and diastolic ve- locities of aorta were detected. The different features were compared between the two groups. Results Test results showed significant differences in study group： Anteroposterior diameter of aortic annulus and the area of aortic valve were decreased by calcification; The anteroposterior diameter of aortic sinus increased and aorta transvalvular pres- sure gradient augmented; Detection rate of atherosclerosis （AS） of aorta and the peripheral artery stenosis of the study group were higher than that of control group; The AS increased pulse pressure and aggravated AVC; Correla- tive risk factors, in addition to age, included hypertension, hypercholesterolemia, osteoporosis, and so on. The cor- rect diagnosis of the correlated diseases were on the basis of clinical examines. The rate of AVC with multi-factor was higher than that with single-factor. In addition, gender difference and the diameters of ascending aortic showed no significant difference in two groups. Relationship between diabetes of correlative factors and the rate of AVC showed no significant difference in two groups. Conclusion Morphologic abnormality and malfunction of aortic valve and the large artery in elder patients were caused by senile degenerative AVC. The more correlative risk fac- tors, the worse showed.