【摘要】 目的 探讨永久性起搏器植入与三尖瓣反流(TR)发生或加重的相关性,分析术后TR发生或加重的其他影响因素。方法 回顾性分析2020年9月～2023年12月于吉林省人民医院行永久性心脏起搏器植入术的患者资料(n=200),患者均行右心室电极植入,术前均行超声心动图检查,排除中、重度TR。将术后新发TR或TR程度与术前比较程度加重的患者纳入加重组(n=86),其余纳入未加重组(n=114)。收集所有患者的年龄、性别、体重指数(BMI)以及高血压、糖尿病、冠心病等并发症发生情况和吸烟史等一般临床资料,记录超声心动图指标以及中性粒细胞/淋巴细胞比值(NLR)、高敏C-反应蛋白(hs-CRP)等实验室指标。比较两组患者的一般临床资料、实验室指标以及超声心动图指标。术后6个月复查超声心动图下TR情况,比较起搏器植入前后患者心脏结构、功能的变化,并分析TR进展的潜在影响因素。结果 将符合纳排标准的200例患者纳入研究,术后新发TR 64例,TR发生率为32.0%。TR未加重共114例(57.0%),其中,无TR发生49例(43.0%)、轻度TR程度不变共65例(57.0%)。新发TR或TR加重86例(43.0%),其中,新发为轻度TR 59例(68.6%)、新发或加重为中度TR 23例(26.7%)、加重为重度TR 4例(4.7%)。两组患者BMI、NLR、hs-CRP差异具有统计学意义(P <0.05)。多因素Logistic回归分析结果显示,BMI为TR发生的独立危险因素[OR=1.200,95%CI(1.083～1.330),P <0.05]。结论 永久性起搏器植入与TR的发生有一定相关性,BMI为TR发生或加重的独立危险因素。更多还原

【Abstract】 Objective To explore the correlation between permanent pacemaker implantation and the occurrence or aggravation of tricuspid regurgitation(TR), and to analyze other influencing factors related for the occurrence or aggravation of TR after surgery. Methods A retrospective analysis was conducted on the medical records of patients who underwent permanent cardiac pacemaker implantation in Jilin Provincial People’s Hospital from September 2020 to December 2023(n=200). All patients underwent right ventricular electrode implantation and underwent preoperative echocardiography to exclude moderate to severe TR. Patients with new-onset TR or aggravated TR compared to preoperative status were included in the aggravated group(n=86), and the rest were included in the non-aggravated group(n=114). General clinical data including age, gender, body mass index(BMI), and the occurrence of complications such as hypertension, diabetes, coronary heart disease, and smoking history were collected.Echocardiographic parameters and laboratory indicators such as the neutrophil-to-lymphocyte ratio(NLR) and high sensitive C-reactive protein(hs-CRP) were recorded. The general clinical data, laboratory indicators, and echocardiographic parameters of the two groups were compared. Echocardiography was performed 6 months after surgery to re-examine the TR condition, and the changes in cardiac structure and function before and after pacemaker implantation were compared. Potential influencing factors for TR progression were analyzed. Results A total of 200 patients who met the inclusion and exclusion criteria were included in the study. There were 64 cases of new-onset TR after surgery, with a TR occurrence rate of 32.0%. There were 114 cases(57.0%) without TR aggravation, including 49 cases(43.0%) without TR and 65 cases(57.0%) with unchanged mild TR. There were 86 cases(43.0%) with new-onset or aggravated TR, including 59 cases(68.6%) with new-onset mild TR, 23 cases(26.7%) with new-onset or aggravated moderate TR, and 4 cases(4.7%) with aggravated severe TR. There were statistically significant differences in BMI, NLR and hs-CRP between the two groups(P<0.05). Multivariate Logistic regression analysis showed that BMI was an independent risk factor for TR occurrence [OR=1.200, 95%CI(1.083～1.330), P<0.05]. Conclusion Permanent pacemaker implantation is associated with the occurrence of TR, and BMI is an independent risk factor for the occurrence or aggravation of TR.更多还原