影响非缺血性心力衰竭患者心肌纤维化的因素分析

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

影响非缺血性心力衰竭患者心肌纤维化的因素分析

王放, 董哲, 孙艺红, 任景怡, 李菁, 周益锋, 郑金刚^*

中日友好医院心脏科,北京 100029

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: ^*mdjingangzheng@163.com
基金资助:
国家自然科学基金(91639110,81700411)

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

WANG Fang, DONG Zhe, SUN Yi-hong, REN Jing-yi, LI Jing, ZHOU Yi-feng, ZHENG Jin-gang^*

Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China

Received:2020-09-14 Revised:2020-12-24 Online:2021-03-05 Published:2021-03-01
Contact: ^*mdjingangzheng@163.com

摘要/Abstract

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(RHC)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(RCP)、肺动脉收缩压(PAP)、肺动脉楔压(PAWP)和全肺阻力(TPR)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(MF), 心内膜心肌活检(EMB), 右心导管(RHC)

Abstract: Objective To investigate the potential factors influencing myocardial fibrosis (MF) in non-ischemic heart failure(HF) patients with an emphasis on the role of right heart catheter (RHC) parameters. Methods This retrospective research collected clinical data from 33 non-ischemic heart failure patients admitted to China-Japan Friendship Hospital who received 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. 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 the 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 non-isch- emic heart failure patients. Cardiologists should pay more attention to high-risk patients in order to retard MF progression through timely intervention.

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

中图分类号:

R541

王放, 董哲, 孙艺红, 任景怡, 李菁, 周益锋, 郑金刚. 影响非缺血性心力衰竭患者心肌纤维化的因素分析[J]. 基础医学与临床, 2021, 41(3): 346-351.

WANG Fang, DONG Zhe, SUN Yi-hong, REN Jing-yi, LI Jing, ZHOU Yi-feng, ZHENG Jin-gang. Analyses of factors influencing myocardial fibrosis in non-ischemic heart failure patients[J]. Basic & Clinical Medicine, 2021, 41(3): 346-351.

参考文献

[1] Liu T, Song D, Dong J, et al. Current understanding of the pathophysiology of myocardial fibrosis and its quantitative assessment in heart failure[J]. Front Physiol, 2017, 8: 238.doi:10.3389/fphys.2017.00238.
[2] Frangogiannis N. Can myocardial fibrosis be reversed?[J]. J Am Coll Cardiol, 2019, 73: 2283-2285.
[3] Díez J, González A, Kovacic J. Myocardial interstitial fibrosis in nonischemic heart disease, part 3/4: JACC focus seminar[J]. J Am Coll Cardiol, 2020, 75: 2204-2218.
[4] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J]. Eur Heart J, 2016, 37: 2129-2200.
[5] Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Associa-tion Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiova-scular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons[J]. Circulation, 2014, 130: 1749-1767.
[6] Pinto YM, Elliott PM, Arbustini E, et al. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases[J]. Eur Heart J, 2016, 37: 1850-1858.
[7] Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35: 2733-2779.
[8] Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases[J]. Eur Heart J, 2013, 34: 2636-2648, 2648a-2648d.
[9] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hyperten-sion[J]. Eur Heart J, 2018, 39: 3021-3104.
[10] Slimani A, Melchior J, de Meester C, et al. Relative contribution of afterload and interstitial fibrosis to myocardial function in severe aortic stenosis[J]. JACC Cardiovasc Imaging, 2020, 13: 589-600.
[11] Kwiecinski J, Lennen R, Gray G, et al. Progression and regression of left ventricular hypertrophy and myocardial fibrosis in a mouse model of hypertension and concomitant cardiomyopathy[J]. J Cardiovasc Magn Reson, 2020, 22: 57.doi:10.1186/s12968-020-00655-7.
[12] Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respira-tory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)[J]. Eur Heart J, 2016, 37: 67-119.

[1]	王振花, 李潮生. 饮食作用的肠道菌群-免疫轴与高血压相关性的研究进展[J]. 基础医学与临床, 2022, 42(6): 983-987.
[2]	何丹, 阮中宝. 细胞外囊泡在心房颤动发病中的作用[J]. 基础医学与临床, 2022, 42(4): 671-674.
[3]	王帅, 王建军, 孙秀红, 邬鹏宇, 崔志成, 李占清. 萝卜硫素减轻心脏移植模型大鼠缺血/再灌注损伤[J]. 基础医学与临床, 2022, 42(3): 411-416.
[4]	张爽, 李之凡, 钱杰, 吴娜琼. 腔内影像学方法评价降脂治疗对冠状动脉粥样硬化斑块影响的研究进展[J]. 基础医学与临床, 2022, 42(3): 366-371.
[5]	刘峰宇, 韩薇. 心肌细胞钙稳态失调在心力衰竭中作用的研究进展[J]. 基础医学与临床, 2022, 42(3): 502-506.
[6]	刘颖娴宋彦君陈未林雪赖晋智黎婧怡吴炜. 非缺血性心力衰竭患者应用伊伐布雷定的有效性与安全性评价[J]. 基础医学与临床, 2021, 41(11): 1637-1642.
[7]	蒙颖张正义赵嫄卢昌宏商波孙鹏飞张德奎. X线放射诱导大鼠心肌细胞系H9c2损伤中组蛋白乙酰化水平降低[J]. 基础医学与临床, 2021, 41(8): 1139-1143.
[8]	王丽庞俊陈庆伟李桂琼柯大智李兴升. Ghrelin改善ApoE-/-小鼠心肌梗死后内皮功能和斑块稳定性[J]. 基础医学与临床, 2021, 41(7): 935-940.
[9]	庄红, 张苏川, 刘慧地, 徐亚宁, 黄璐, 代天, 蒋品. 沉默CXCL12抑制ox-LDL诱导小鼠巨噬细胞系RAW264.7泡沫化和凋亡[J]. 基础医学与临床, 2021, 41(2): 219-224.
[10]	秦桃, 李青, 李菊香. 成纤维细胞生长因子同源因子1在心律失常发病机制中的研究进展[J]. 基础医学与临床, 2020, 40(12): 1697-1700.
[11]	杨玲, 杜雪平. 北京市西城区急性冠脉综合征住院患者的诊断治疗分析[J]. 基础医学与临床, 2020, 40(12): 1681-1685.
[12]	郭方君, 杨人强. 血小板微粒促进动脉粥样硬化发生的研究进展[J]. 基础医学与临床, 2020, 40(11): 1551-1555.
[13]	冯冬萍, 商汉桥, 杨航, 张虎军, 张停, 杨梦溪, 屠强, 任景怡. 斑马鱼cetp基因敲除模型的建立及其肝脏转录组学分析[J]. 基础医学与临床, 2020, 40(7): 940-947.
[14]	王美惠毕徐堃傅国胜. 瑞舒伐他汀减轻脂多糖诱导的人晚期内皮祖细胞损伤[J]. 基础医学与临床, 2019, 39(6): 769-775.
[15]	张虎薛小琴张晓菲. 高原红细胞增多症与碎裂QRS波相关[J]. 基础医学与临床, 2019, 39(6): 851-854.