老年二尖瓣反流住院患者治疗方案选择的相关因素分析

Factors associated with the election of treatment options for mitral regurgitation in elderly inpatients

目的分析老年二尖瓣反流（MR）住院患者的临床特征与诊疗现状，探讨影响老年MR患者治疗方案选择的因素。方法本研究为大型单中心回顾性研究，连续人选2014年5月1日至2015年4月30日入住中国医学科学院阜外医院并经心脏超声检查确诊为中度及中度以上MR的老年患者680例，根据对MR治疗方式分为手术组372例和药物组308例（45．3％），收集患者临床资料，分析影响老年MR患者治疗方案选择的因素。结果与手术组比较，药物组患者平均年龄大、原发性MR比例低、合并冠心病比例高、入院Euroscore-Ⅱ评分高（均P〈0．01）。药物组中度反流患者比例较手术组低，24．4％（75／308）比53．8％（200／372）；平均左心室射血分数（LVEF）低，（47.8±16．1）％比（61．5±9．2）％；左心室舒张末期内径大，（59．2±11．4）mm比（55．8±8．8）mm（均P〈0．01）。多因素分析结果显示，影响老年MR住院患者治疗方案选择的因素为MR程度、LVEF值、联合瓣膜病变、年龄、糖尿病（OR=62．067、1．089、4．791、0．879、0．414，P〈0．01或P〈0．05）。结论45．3％的老年MR患者只接受药物治疗。增龄、非重度MR、LVEF值减低、合并糖尿病、无联合瓣膜病变是老年MR患者未手术干预的重要因素。

Objective To review the clinical characteristics and current management strategy and to examine the factors to be considered in the selection of treatment options for mitral regurgitation （MR） in elderly inpatients. Methods Elderly patients（≥ 60years old）who had been diagnosed with moderate to severe MR by transthoracic echocardiography and hospitalized from May 1, 2014 to April 30, 2015were included in this study （N= 680）. Patients were grouped according to therapy： the surgery group （n= 372） and the medication group （n= 308）. Data at baseline including medical history and echocardiography were collected for comparison between the two groups and for analysis of factors associated with treatment choice. Results Of the 680 patients with moderate to severe MR, 45.3% were treated with medication. Compared with the surgery group, patients in the medication group were older, with a Iower prevalence of primary MR, a higher prevalence of coronary heart disease and higher Euroscore-Ⅱ scores （all P〈0.01）. Furthermore, the medi.cation group had a lower prevalence of moderate MR（75/308 or 24.4% w 200/372 or 53.8 %, P〈 0.01 ）, a lower left ventrieular ejection fraction （47. 8± 16.1 ）% vs （61.5 9.2） %（ P〈0. 01）, and a larger left ventricular end diastolic diameter（59.2± 11.4）mmw （55.8±8. 8）mm （P± 0.01）. Besides, multivariable analysis revealed that regurgitation grade, left ventricular ejection fraction, multiple valve disease, age, and diabetes were correlated with therapy decisions（OR： 62. 067, 1. 089, 4. 791, 0. 879 and 0. 414, respectively, P〈0. 01 or P〈0.05）. Conclusions Old age, impaired left ventricular ejection fraction, low regurgitation grade, diabetes, and absence of multiple valves are the most salientfactors for which surgery should not be selected.