【作者】 王丹；

【导师】 张健；

【作者基本信息】 首都医科大学 ， 老年医学， 2013， 硕士

【摘要】 目的：分析比较老年舒张功能不全患者及射血分数保留心力衰竭患者的临床特点，探讨老年射血分数保留心力衰竭的危险因素。方法：采用回顾性分析的方法，研究对象选取2011年12月-2012年12月期间，于北京友谊医院干部医疗保健中心住院治疗的患者，年龄≥60岁，左室射血分数（LVEF）>45%。根据超声心动图检查结果，首先将研究对象分为舒张功能正常组（即CON组）和舒张功能不全组（即DD组）。舒张功能不全组根据是否出现心力衰竭临床症状或体征进一步分为老年射血分数保留心力衰竭组（HFPEF组）和老年无症状舒张功能不全组（ADD组）。收集患者一般资料，用M超测量左房内径、左室内径、左室后壁厚度、室间隔厚度，按照校正体积法（Teich）计算射血分数（EjectionFraction，EF）；用脉冲多普勒测量二尖瓣血流频谱E峰、A峰；用组织多普勒(tissueDopplerimaging，TDI)在二尖瓣环室间隔、侧壁，两处测量心肌长轴方向舒张期早期峰速(E’)；计算E/A、E/E’、左室壁质量指数（LeftVentricularMassIndex，LVMI）。用SPSS17.0统计软件进行数据分析，两组计量资料的比较用独立样本t检验，计数或等级资料的比较用卡方检验。危险因素的分析用逐步Logistic回归。P<0.05定义为有统计学显著差异。结果：1、共收集老年患者275例，CON组41例，DD组234例，其中DD组老年HFPEF患者130例，老年人群中左室舒张功能不全发生率为85.09%，HFPEF发生率为47.27%。2、与舒张功能正常老人相比，DD组患者年龄大，高血压病发病率高，E’降低，E/E’升高，左室壁质量指数升高，差异有统计学意义（P<0.05）；其中年龄、高血压与左室舒张功能不全具有相关性。3、与ADD组患者相比，HFPEF组患者年龄更大，吸烟率高，高血压病、冠心病、慢性肾脏病、及慢性阻塞性肺疾病发病率升高，左房内径、左室收缩径、左室壁质量指数、E/E’升高，而LVEF、E/A、E’降低，差异均有统计学意义（P<0.05）；其中慢性阻塞性肺疾病、冠心病、慢性肾功能不全及高血压为老年射血分数保留心力衰竭的显著危险因素。结论：1、本研究老年人群中左室舒张功能不全发生率为86.03%，HFPEF发生率为47.27%。2、老年左室舒张功能不全的危险因素主要是年龄和高血压；HFPEF的主要危险因素为COPD、冠心病、慢性肾功能不全和高血压、E/E’。3、老年舒张功能不全患者存在左室向心性肥厚改变，HFPEF患者同时存在左房结构改变。4、即使舒张功能表现正常的患者也可能已存在左室主动松弛功能受损；E/E’与HFPEF相关性优于其他超生心动图参数。更多还原

【Abstract】 Objective:To evaluate comprehensively left ventricular diastolic function in elderly patients with Echocardiography Figure and TDI technology, analysis and compare the incidence, risk factors, cardiac structure, function impairment of the similarities and differences in ADD and HFPEF patients, to find a breakthrough to prevent or delay the occurrence and development of heart failure.Methods:Select patients who were hospitaled and accepted echocardiography, age≥60years, LVEF>45%, at the Beijing Friendship Hospital cadres healthcare center during December2011and December2012. According to echocardiography results, the study group:①diastolic function in the normal group (CON group);②diastolic dysfunction group (DD group), according to whether the heart failure symptoms or signs are divided into elderly HFPEF group and elderly ADD group. M ultra measurement of left ventricular wall thickness, septal thickness, left ventricular internal diameter measurement with improved Simpson2section left LVEF; mitral inflow E peak, A peak pulse Doppler measurement; Tissue Doppler imaging in mitral annular interventricular septum, sidewall, two measuring myocardial long axis of early diastolic peak speed (Em); calculate the E/A, E/Em, left ventricular wall mass index. SPSS17.0statistical analysis, P<0.05was considered statistically significant.Results:①collected275cases of elderly patients, CON group was41cases, DD group was234cases, among them HFPEF patient were130cases, the left ventricular diastolic dysfunction prevalence was86.03%in elderly population, the HFPEF prevalence was47.27%.②Compared with the normal diastolic function elderly, DD patients were older, hypertension disease incidence rate was high, the E’decreased, E/E’and left ventricular wall mass index increased, the difference was statistically significant (P<0.05); the age and hypertension was associated with left ventricular diastolic dysfunction.③Compared with patients of group ADD, HFPEF patients, who were older, higher smoking rate, higher hypertension, higher coronary heart disease rate, higher chronic kidney disease rate, and higher chronic obstructive pulmonary disease incidence rate, left atrial diameter, left ventricular diameter, left ventricular wall mass index all increased, E/E’, LVEF, E/A, E’ all reduced, the difference was statistically significant (P<0.05); chronic obstructive pulmonary disease, coronary heart disease, chronic renal failure and hypertension were risk factors of heart failure significantly.Conclusion:①left ventricular diastolic dysfunction prevalence was86.03%in elderly people, the prevalence of HFPEF was47.27%.②the risk factors of left ventricular diastolic dysfunction were age and hypertension; the main risk factors of HFPEF were COPD, coronary heart disease, chronic renal dysfunction and hypertension.③Elderly patients with diastolic dysfunction had changed concentric hypertrophy of left ventricular, patients with HFPEF also existed changes in left atrial structure.④even though the diastolic function showed normal, patients may also have injured in active relaxation function of left ventricular; E/E’was better correlation with HFPEF than other echocardiography parameters.更多还原