刘明,潘健源,王昌会,程自平,王晓晨,马礼坤

• 1:安徽医科大学附属省立医院心血管内科
• 2:安徽医科大学第一附属医院心血管内科
• 3:安徽医科大学第四附属医院心血管内科
• 4:安徽医科大学第二附属医院心血管内科

摘要(Abstract)：

目的 探讨室间隔厚度（IVST）与梗阻性肥厚型心肌病（HOCM）患者酒精室间隔消融术（ASA）预后的相关性。方法 回顾性连续入选2010年8月至2021年8月在安徽医科大学附属省立医院、安徽医科大学第一附属医院、安徽医科大学第二附属医院、安徽医科大学第四附属医院的心血管内科经ASA治疗的HOCM患者149例。根据患者术前的IVST，采用二分位法分为IVST≤21mm组和IVST>21mm组。收集HOCM患者的一般临床资料、手术资料及住院期间并发症资料，并通过电话随访患者的心功能改善情况、生存情况等。将可能影响ASA术后患者生存率的因素纳入多因素Cox回归模型，分析确定全因死亡的独立危险因素。两组患者的生存分析采用KaplanMeier法，同时使用Log-rank法进行组间比较。结果 IVST≤21mm组有88例（59.1%）患者，IVST>21mm组有61例（40.9%）。所有患者的术后平均左心室流出道压力阶差（LVOTG）、平均IVST均较术前明显下降（P<0.001）。ASA术后超声心动图提示，IVST≤21 mm组与IVST>21mm组相比，LVOTG的降低更为明显（P <0.05）。术后IVST≤21mm组的纽约心脏病协会（NYHA）心功能分级更好（P=0.033），但是有更多的围术期并发症发生（P=0.015）。所有患者平均随访时间为（4.1±2.2）年，IVST≤21 mm组中有4例（4.5%）患者死亡，IVST>21 mm组9例（15.0%）死亡。IVST≤21 mm组的永久性起搏器植入率有多于IVST>21 mm组的趋势，但差异无统计学意义（P>0.05）。长期随访IVST≤21 mm组的NYHA心功能分级优于IVST>21 mm组（P=0.039）。多因素Cox回归分析结果表明，全因死亡率的独立危险因素是IVST(HR 1.163,95%CI1.018～1.329,P=0.026)。Kaplan-Meier生存分析结果表明，ASA术后IVST≤21mm组的无全因死亡生存率高于IVST>21mm组（P=0.014）。结论 ASA能够有效减小HOCM患者的IVST，并降低LVOTG，进而不同程度地改善患者的心功能和临床症状。IVST≤21mm组与IVST>21mm组相比，术后并发症发生率更高，但远期预后较好。IVST与HOCM患者ASA的预后相关。

关键词(KeyWords)： 酒精室间隔消融;梗阻性肥厚型心肌病;室间隔厚度

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（82170263）

作者(Author): 刘明,潘健源,王昌会,程自平,王晓晨,马礼坤

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