影响非缺血性心力衰竭患者心肌纤维化的因素分析

Analyses of factors influencing myocardial fibrosis in non-ischemic heart failure patients

目的探讨影响非缺血性心衰(HF)患者心肌纤维化(MF)的因素,重点关注右心导管(RHC)参数对MF的影响。方法分析33例中日友好医院心脏科住院患者的临床数据,均为接受心内膜心肌活检和右心导管检查的非缺血性心衰患者。Masson染色定量检测MF严重程度。使用K-means聚类分析将患者分为轻度MF(n=17)和重度MF(n=16)两类,并对影响MF的因素进行统计学分析。结果重度MF患者的心功能恶化程度显著高于轻度MF患者(心脏指数,2.15±0.76 vs.2.94±1.10,P<0.05),右心室收缩压(RCP)、肺动脉收缩压(PAP)、肺动脉楔压(PAWP)和全肺阻力(TPR)也显著高于轻度MF患者(P<0.05)。多因素线性回归分析提示,高血压病史和全肺阻力是非缺血性心衰患者MF的独立影响因素(Adjusted R^(2)=0.454,P<0.001)。结论反映左心和右心后负荷的两个因素与非缺血性心衰患者MF严重程度独立相关。临床医生应关注高危患者,及时干预,尽量延缓非缺血性心衰患者MF的进展。

Objective To investigate the potential factors influencing myocardial fibrosis(MF)in non-ischemic heart failure(HF)patients with an emphasis on the role of right heart catheter(RHC)parameters.Methods This retrospective research collected clinical data from 33 non-ischemic heart failure patients admitted to China-Japan Friendship Hospital who received endomyocardial biopsy(EMB)and right heart catheter(RHC)examination.All the patients were divided into two groups:mild MF(n=17)and severe MF(n=16),by means of K-means cluster analysis.MF was quantitatively evaluated by Masson staining.Potential factors influencing MF were analyzed.Results Compared with that in mild MF group,patients in severe MF group had aggravated cardiac function(cardiac index,2.15±0.76 vs.2.94±1.10,P<0.05),accompanied by higher systolic right ventricle pressure(RVP),systolic pulmonary arterial pressure(PAP),pulmonary arterial wedge pressure(PAWP)and total pulmonary resistance(TPR)(P<0.05).Hypertension and TPR were independently correlated with the degree of MF in multiple linear regression analysis(Adjusted R^(2)=0.454,P<0.001).Conclusions Hypertension and TPR,reflecting afterload of left and right ventricle,are found to be independently correlated with degree of MF in non-isch-emic heart failure patients.Cardiologists should pay more attention to high-risk patients in order to retard MF progression through timely intervention.