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ENGLISH ABSTRACT
风湿性二尖瓣成形手术疗效的影响因素分析
贾崧淏
王茂舟
韩杰
姜文剑
张宏家
作者及单位信息
·
DOI： 10.3760/cma.j.cn112434-20240407-00100
Analysis of influencing factors on the outcome of rheumatic mitral valve repair
Jia Songhao
Wang Maozhou
Han Jie
Jiang Wenjian
Zhang Hongjia
Authors Info & Affiliations
Jia Songhao
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Wang Maozhou
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Han Jie
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Jiang Wenjian
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Zhang Hongjia
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
·
DOI： 10.3760/cma.j.cn112434-20240407-00100
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摘要

目的探索影响风湿性二尖瓣成形手术疗效的影响因素，从而筛选合适的患者接受风湿性二尖瓣成形手术。

方法纳入从2016年1月到2022年3月间876例拟接受风湿性二尖瓣成形手术的患者，通过术前超声心动图和心脏CT多模态影像方法评估患者二尖瓣病变，将成功完成风湿性二尖瓣成形手术且无超过轻度的狭窄或反流定义为良好修复，通过单因素和多因素 logistics回归分析影响风湿性二尖瓣成形手术疗效的影响因素。

结果493例(56.2%)患者完成了效果良好的风湿性二尖瓣成形手术，体质量指数、纽约心功能分级、左心房直径、二尖瓣狭窄程度、二尖瓣反流程度、二尖瓣Agatston评分、乳头肌腱索融合是影响风湿性二尖瓣成形手术疗效的独立影响因素。

结论在风湿性二尖瓣病变中约60%的患者可完成效果良好的二尖瓣成形手术，二尖瓣钙化程度是影响风湿性二尖瓣成形手术疗效的独立危险因素。

风湿性二尖瓣病变;二尖瓣成形术;二尖瓣置换术;超声心动图
ABSTRACT

ObjectiveTo explore the influencing factors on the outcome of rheumatic mitral valve repair, to screen suitable patients for rheumatic mitral valve repair.

MethodsA total of 876 patients who planned to undergo rheumatic mitral valve repair between January 2016 and March 2022 were included in the study. Preoperative echocardiography and cardiac CT imaging were used to evaluate mitral valve disease in patients. Successful completion of rheumatic mitral valve repair without over mild stenosis or regurgitation was defined as satisfactory repair. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors on the outcome of rheumatic mitral valve repair.

Results493 patients (56.2%) completed satisfactory rheumatic mitral valve repair. BMI, NYHA classification, left atrial diameter, degree of mitral stenosis, degree of mitral regurgitation, Agatston score, and papillary tendon fusion were independent influencing factors on the outcome of rheumatic mitral valve repair.

ConclusionNearly 60% of patients with rheumatic mitral valve disease could complete satisfactory rheumatic mitral valve repair, and the degree of mitral valve calcification was an independent risk factor affecting the outcome of rheumatic mitral valve repair.

Rheumatic mitral valve disease;Mitral valve repair;Mitral valve replacement;Echocardiogram
Zhang Hongjia Email: nc.defudabe.umcc227aijgnohgnahz
Copyright by Chinese Medical Association
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引用本文

贾崧淏,王茂舟,韩杰,等. 风湿性二尖瓣成形手术疗效的影响因素分析[J]. 中华胸心血管外科杂志,2025,41(03)：163-167.

DOI:10.3760/cma.j.cn112434-20240407-00100

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风湿性心脏病是最常见的心血管疾病之一，据估算全球范围内现有风湿性心脏病患者约4 050万例，每年造成超过30万人死亡 [ 1 , 2 , 3 ]。风湿性心脏瓣膜病仍是我国瓣膜病的首要病因 [ 4 ]，其中超过九成的患者最先累及二尖瓣 [ 5 , 6 ]，给社会和患者家庭带来沉重的疾病负担 [ 7 ]，因此探索风湿二尖瓣病变的最佳治疗策略是当前重要的临床问题。
我国专家共识推荐对于符合条件的患者优先选择风湿性二尖瓣修复的治疗方案 [ 8 ]。2020年美国心脏协会瓣膜指南也指出，当解剖结构有利时，可以首选交界切开术进行二尖瓣成形手术 [ 9 ]。北京安贞医院瓣膜外科中心通过多年临床实践探索出了针对风湿性二尖瓣病变SCORE四步法成形技术 [ 10 , 11 ]，前期研究证实应用该技术进行风湿性二尖瓣成形手术，在中长期随访期间的死亡、瓣膜相关并发症和再次手术方面均显著优于行二尖瓣置换手术 [ 10 ]。
在退行性病变中，很多学者主张"全部修复"的观念，即对所有患者均尝试修复 [ 12 ]。但在风湿性病变中成形手术可能并不适用于所有患者，因此需要分析风湿性二尖瓣成形手术疗效的影响因素，从而在临床实践中筛选合适的患者进行风湿性二尖瓣成形手术。本研究纳入了拟进行成形手术的876例风湿性二尖瓣患者，通过多模态影像方法分析患者病变特点，旨在发现影响风湿性二尖瓣成形手术疗效的影响因素，从而筛选合适的患者接受风湿性二尖瓣成形手术，改善患者预后。
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备注信息
A
张宏家　Email: nc.defudabe.umcc227aijgnohgnahz
B

贾崧淏：数据整理、统计学分析、论文撰写；王茂舟、韩杰：数据整理、研究指导；姜文剑、张宏家：研究指导、论文修改、经费支持

C
所有作者均声明不存在利益冲突
D
国家重点研发计划 (2021YFC2501104)
国家自然科学基金 (82170487，82241205)
首都医科大学附属北京安贞医院重大科技创新研发专项 (KCZD202203)
首都医科大学附属北京安贞医院前沿技术预探索项目 (KCQY202201)
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