中重度心脏瓣膜病患者临床特征分析

Clinical characteristics of patients with moderate or severe valvular heart disease

目的描述中重度心脏瓣膜病门诊/住院患者的人群特点、病因及瓣膜病变类型。方法本研究为横断面研究。基于陆军军医大学第一附属医院大数据平台,对2001年1月1日至2020年1月1日门诊及住院首次行超声心动图检查且诊断为中重度心脏瓣膜病患者的年龄、性别特征,病因和瓣膜病变类型等进行描述分析。结果共纳入中重度心脏瓣膜病患者68354例,年龄63(50,72)岁,其中女性35706例(52.24%)。(1)年龄特征:男性与女性中重度心脏瓣膜病患者数量随年龄变化的趋势相似,均呈先增后减,峰值拐点在65~69岁年龄段。二尖瓣狭窄患病数在45~49岁年龄段达到峰值,较整体前移。二叶式主动脉瓣患者的中位年龄为42岁。(2)性别特征:女性中重度瓣膜病患者中三尖瓣反流、肺动脉瓣反流、二尖瓣反流、二尖瓣狭窄占比以及接受瓣膜手术的比例均明显高于男性,男性中重度瓣膜病患者中主动脉瓣反流、主动脉瓣狭窄及二叶式主动脉瓣的比例高于女性(P均<0.05)。(3)病因:风湿性心脏瓣膜病占比13.07%(8934/68354),高于退行性病变的0.67%(458/68354)。(4)瓣膜病变类型:三尖瓣反流占比最高[60.72%(41503/68354)],此后依次为二尖瓣反流、主动脉瓣反流、二尖瓣狭窄、肺动脉瓣反流、主动脉瓣狭窄。结论我国西南地区中重度心脏瓣膜病患病情况存在一定的地域性特征,在全程精细化管理上应有所不同。

Objective To describe the characteristics,etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease(VHD).Methods This is a cross-sectional study.Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1 st January 2001 to 1 st January 2020 in Southwest Hospital,Army Medical University were enrolled.Data were collected from medical records and big data platform of Southwest Hospital.Characteristics of age and gender,etiology and types of VHD were descriptively analysed.Results A total of 68354 patients with moderate or severe VHD were enrolled.The age was 63(50,72)years.And 35706(52.24%)patients were female.(1)Age characteristics:There was similar age trend between male and female patients with moderate or severe VHD.The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old.The peak age of mitral stenosis patients was 45-49 years,which was earlier than that of whole patients with moderate or severe VHD.The median age of patients with bicuspid aortic valve was 42 years.(2)Gender characteristics:The proportion of tricuspid regurgitation,pulmonary regurgitation,mitral regurgitation,mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients.The proportion of aortic regurgitation,aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients(all P<0.05).(3)Etiology:The proportion of rheumatic VHD was 13.07%(8934/68354),which was higher than that of degenerative VHD(0.67%(458/68354)).(4)Types of VHD:Tricuspid regurgitation made contribution to the largest proportion with 60.72%(41503/68354),followed by mitral regurgitation,aortic regurgitation,mitral stenosis,pulmonary regurgitation and aortic stenosis.Conclusions There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China,suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.