老年钙化性心脏瓣膜病临床分析

Clinical analysis of calcific valvular heart disease in the elderly

摘要:

目的 探讨老年钙化性心脏瓣膜病(CVHD)患者的临床特点.方法 230例60岁以上经超声心动图诊断CVHD患者,回顾性分析了临床表现、超声心动图和其他辅助检查资料.结果 CVHD常伴发高血压病、冠心病、糖尿病等疾病.受累瓣膜以主动脉瓣最常见,二尖瓣次之.无冠瓣钙化多于左、右冠瓣,瓣膜反流多于狭窄,二尖瓣钙化女性多于男性.常见心脏功能受损为左心舒张功减低(82.3%)、左房增大(37.1%)和左室增大(18.5%).心律失常主要为期前收缩(41.7%)、心房颤动(20.4%)、房室传导阻滞(16.1%).胸部X线检查71.7%有主动脉弓钙化;生化检查62.6%有血脂异常.结论 CVHD临床表现和实验室检查具有一定特点,而主动脉弓钙化有助于诊断,但确诊仍需借助超声心动图.

Abstract:

Objective To discuss the clinical characteristics of the elderly patients with calcific valvular heart disease (CVHD). Methods The clinical data of 230 CVHD patients aged over 60 years were enrolled. The diagnosis was confirmed by echocardiography. The patients’ data were retrospectively analyzed,including clinical manifestation,the results of echocardiography and other adjunctive examinations. Results CVHD was usually complicated by hypertension,coronary artery disease,and diabetes mellitus. In which,aortic valve was most frequently involved,followed by mitral valve. The calcified regions were more frequently seen in non coronary cusp than in right or left coronary cusp. The incidence of valvular regurgitation was higher than that of valvular stenosis. The incidence of mitral calcification was significantly higher in female than in male. The common cardiac function impairments were left ventricular diastolic dysfunction (82.3%),left atrial enlargement (37.1%) and left ventricular enlargement (18.5%). The common arrhythmia included premature beat (41.7%),atrial fibrillation (20.4%) and atrioventricular block (16.1%). Chest X-ray test revealed aortic arch calcification in 77.5% of cases. Biochemical test displayed dyslipidemia in 62.6% of patients. Conclusion CVHD has certain specific clinical manifestations and laboratory examination findings. The aortic arch calcification is helpful for its diagnosis. But,echocardiography is mandatory to reach a definite diagnosis of CVHD.