经皮左房室瓣球囊扩张术对风湿性左房室瓣狭窄患者血栓前状态的影响

Effect of Percutaeous Balloon Mitral Valvuloplasty on Prethromboticstate of Patients With Rheumatic Mitral Stenosis

目的观察经皮左房室瓣球囊扩张术(PBMV)对风湿性左房室瓣狭窄(RMS)患者血栓前状态的影响。方法选取2009年3月—2014年5月在临沂市沂水中心医院就诊的RMS患者69例为观察组。同期选取临沂市沂水中心医院体检中心体检健康者27例为对照组。所有患者于PBMV前及PBMV后4周行超声心动图检测,记录左房室瓣口面积(MVA)、左心房内径(LAD)、右心房内径(RAD)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、右心室收缩末期内径(RVEDs)。对照组于体检当天、观察组于PBMV前及PBMV后4周检测平均血小板体积(MPV)及P选择素(PS)水平。结果观察组PBMV后MVA大于PBMV前,LAD、LVEDd小于PBMV前(P<0.05);观察组PBMV前后RAD、LVEDs、RVEDs比较,差异无统计学意义(P>0.05)。观察组PBMV前MPV、PS水平高于对照组(P<0.05);观察组PBMV后MPV、PS水平与对照组比较,差异无统计学意义(P>0.05);观察组PBMV前MPV、PS水平高于PBMV后(P<0.05)。PBMV前MPV与MVA呈负相关,与PS呈正相关(P<0.05);PBMV前MPV与LAD、RAD、LVEDd、LVEDs、RVEDs无直线相关关系(P>0.05)。PBMV前PS与MVA呈负相关(P<0.05);PBMV前PS与LAD、RAD、LVEDd、LVEDs、RVEDs无直线相关关系(P>0.05)。结论 PBMV是治疗RMS的有效措施,可改善RMS患者的临床症状,且可以有效降低MPV及PS水平,对改善血栓前状态可能有益。

Objective To observe the effects of Percutaeous Balloon Mitral Valvuloplasty （ PBMV ） on prethromboticstate of patients with rheumatic mitral stenosis（RMS）. Methods 69 patients with RMS from March 2009 to May 2014 in Yishui Central Hospital of Linyi were selected as the observation group,and 27 healthy subjects who had physical examinations in Physical Examination Center of Yishui Central Hospital of Linyi were selected as the control group. All patients had echocardiography 4 weeks before and after PBMV. Mitral valve area（ MVA）,left atrial diameter（ LAD）,right atrial diameter（RAD）,left ventricular end diastolic dimension（LVEDd）,left ventricular end systolic diameter（LVEDs）and right ventricular end diastolic diameter（RVEDs）were recorded. Mean platelet volume（MPV）and the level of P - selectin（PS）of subjects in the control group were measured when they had physical examinations,while those of patients in the observation group were measured before and 4 weeks after PBMV. Results In the observation group,MVA after PBMV was larger than that before PBMV,and LAD and LVEDd were smaller than those before PBMV（P ﹤ 0. 05）;there were no significant differences among RAD,LVEDs and RVEDs before and after PBMV（P ﹥ 0. 05）. The levels of MPV and PS in the observation group were higher than those in the control group before PBMV（P ﹤ 0. 05）;there were no significant differences in the levels of MPV and PS after PBMV between the observation group and the control group（ P ﹥ 0. 05）;the levels of MPV and PS before PBMV in the observation group were higher than those after PBMV（P ﹤ 0. 05）. Before PBMV,MPV were negatively correlated with MVA and positively correlated with PS（P ﹤ 0. 05）;before PBMV,MPV had no linear correlation with LAD,RAD,LVEDd,LVEDs and RVEDs（P ﹥ 0. 05）. Before PBMV,PS was negatively correlated with MVA（ P ﹤ 0. 05）;before PBMV,PS had no correlation with LAD,RAD,LVEDd,LVEDs and RVEDs. Conclusion PBMV is an effective measure for RMS. It could improve the clinical symptoms of patients with RMS,and effectively reduce the levels of MPV and PS,which may be beneficial to improve the prethrombosis state.