大动脉炎心脏瓣膜受累临床分析

Clinical analysis of Takayasu disease with heart valvular involvement

目的了解心脏瓣膜受累在大动脉炎患者中的发病情况，分析大动脉炎其临床特点。方法选取91例北京协和医院住院大动脉炎患者，通过超声心动图检查心脏瓣膜病变，对合并与未合并瓣膜病变患者的临床资料进行比较。应用t检验、Mann-Whitney U检验、χ2检验或Fisher确切概率法进行统计学分析。结果大动脉炎患者心脏瓣膜受累以瓣膜关闭不全为主，其中主动脉瓣关闭不全20例（22%），二尖瓣关闭不全20例（22%），三尖瓣关闭不全10例（11%），肺动脉瓣关闭不全2例（2%）。起病年龄晚、病程长、合并有高血压或升主动脉扩张的患者出现主动脉瓣关闭不全的比例明显升高（t=2.903，P〈0.01；Z=-2.759，P〈0.01；χ2=7.918，P〈0.01；Z=-4.454，P〈0.01）。大动脉炎患者一般症状、ESR和CRP的升高在合并和未合并瓣膜关闭不全的2组患者中的差异无统计学意义（P均〉0.05）。3例大动脉炎患者主动脉置换术后的病理检测均未发现有炎性细胞浸润。结论心脏瓣膜受累在大动脉炎患者中较常见，以主动脉瓣关闭不全和二尖瓣关闭不全最多见。大动脉炎患者的瓣膜受累以继发性改变为主，主动脉瓣关闭不全主要继发于高血压和升主动脉扩张，二尖瓣关闭不全继发于左心扩大病变。在大动脉炎诊治过程中应重视心脏瓣膜病变的筛查与诊治。

ObjectiveTo estimate the frequency of heart valvular involvement in Chinese patients with Takayasu arteritis （TAK） and its correlation with other clinical features.MethodsNinety-one patients with TAK were studied and their clinical manifestations, laboratory test, vascular images and echocardiographic findings were retrospectively reviewed. The data were compared between patients who had heart valvular involvement and those who had not. Mann-Whitney U-test or Student＇s t-test, Chi-squared test or Fisher＇s exact test were used for analysis.ResultsAortic regurgitation and mitral regurgitation were both confirmed in 20（22%） patients. Tricuspid regurgitation and pulmonary valve regurgitation were observed in 10（11%） and 2（2%） patients, respectively. Older age at onset, longer disease duration, hypertension and involvement of the ascending aorta were all significantly more frequent in TAK patients with aortic regurgitation （t=2.903, P〈0.01; Z=-2.759, P〈0.01; χ2=7.918, P〈0.01; Z=-4.454, P〈0.01） than those without. However, the constitutional symptoms and acute phase reactants [erythrocyte sedimentation rate （ESR） and C reactive protein （CRP）] were not statistically different between patients with and without valvular regurgitation （P〉0.05）. Aortic valvular pathology examination of the three TAK patients who had underwent aortic valve replacement showed no inflammatory cell infiltration. ConclusionThis study has demonstrated that heart valve involvement is common in patients with TAK, mainly in the form of regurgitation, and which may be secondary to hypertension and other cardiovascular complications. We should pay more attention to the screening and treatment of heart valvular involvement in TAK patients.