基础医学与临床 ›› 2021, Vol. 41 ›› Issue (3): 346-351.

• 研究论文 • 上一篇    下一篇

影响非缺血性心力衰竭患者心肌纤维化的因素分析

王放1,董哲1,孙艺红1,任景怡2,李菁1,周益锋1,郑金刚1   

  1. 1. 中日友好医院
    2. 北京大学中日友好临床医学院;中日友好医院心内科
  • 收稿日期:2020-09-14 修回日期:2020-12-24 出版日期:2021-03-05 发布日期:2021-03-01
  • 通讯作者: 郑金刚 E-mail:mdjingangzheng@163.com
  • 基金资助:
    三羟基黄酮(黄芩素)对于小鼠主动脉夹层病变的影响及其表观遗传学机制研究;ADAMTS1通过调节中性粒细胞浸润影响主动脉夹层的机制研究

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

  • Received:2020-09-14 Revised:2020-12-24 Online:2021-03-05 Published:2021-03-01

摘要: 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、肺动脉收缩压、肺动脉楔压和全肺阻力也显著高于轻度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 R2=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。

关键词: 非缺血性心力衰竭, 心肌纤维化, 心内膜心肌活检, 右心导管

Abstract: Objective To investigate the potential factors influencing myocardial fibrosis (MF) in nonischemic heart failure patients with an emphasis on the role of right heart catheter (RHC) parameters. Methods We assessed the clinical data from 33 nonischemic heart failure patients admitted to China-Japan Friendship Hospital who receiving 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 statistically. 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 degree of MF in multiple linear regression analysis (Adjusted R2=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 nonischemic heart failure patients. Cardiologists should pay more attention to high-risk patients in order to retard MF progression through timely intervention.

Key words: nonischemic heart failure, myocardial fibrosis (MF), endomyocardial biopsy (EMB), right heart catheter (RHC)

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