Incidence and clinical characteristics of mitral regurgitation in Xinjiang: A single-center 10-year ultrasound data analysis
-
摘要: 目的 分析二尖瓣反流(mitral regurgitation，MR)患者患病率以及心脏彩超特点。 方法 本研究为大样本单中心回顾性研究，连续入选2012年1月—2022年12月在新疆医科大学第一附属医院首次就诊行超声心动图的患者资料。基于心脏彩超结果，对MR患者资料进行分析，总结和归纳MR患病情况以及心脏彩超相关指标。 结果 共纳入32个民族150 190例患者，MR患者的平均年龄为(61.90±15.05)岁，男女之比为1：1.5。共检出MR患者31 495例，检出率为20.97%，在MR患者中，轻度(1+)、中度(2+)、中-重度(3+)、重度(4+)的患病率分别为13.73%、2.9%、0.46%、0.56%，随着年龄的增长患病率有增高趋势。1+ MR中女性在各个年龄组的患病率均高于男性(P＜0.001)。不同民族间，维吾尔族3+以上反流占比最大，汉族占比最低。无论是退行性MR(DMR)还是功能性MR(FMR)，左心房内径(LAD)、左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、左室射血分数(LVEF)都与MR相关联(均P＜0.001)，其中随着LVEF减小及LVSD、LAD增大，3+以上MR的占比升高。1 501例3+及以上的MR患者中，531例(35.38%)患者为FMR，合并风湿性心脏病为227例(15.12%)，合并感染性心内膜炎为33例(2.20%)，合并瓣膜退行性病变为599例(39.91%)。 结论 MR发病率较高，是常见的心脏瓣膜疾病。男性与女性患病率存在差异。不同民族也有不同的发病特点。随着LVEF减小及LVSD增大，患者更易出现3+及以上MR。合并心脏原发疾病及瓣膜退行性病变的患者更易演变为重度MR。Abstract: Objective To summarize and analyze the prevalence of single-center large-sample mitral regurgitation(MR) patients and the characteristics of cardiac ultrasound. Methods This study was a large-sample, single-center retrospective study, and the data of patients who underwent echocardiography for the first time in the First Affiliated Hospital of Xinjiang Medical University from January 2012 to December 2022 were continuously enrolled. Based on the results of cardiac ultrasound, the data of MR patients were analyzed, and the prevalence of MR and the related indexes of cardiac ultrasound were summarized. Results A total of 150, 190 patients from 32 ethnic groups were enrolled, and the average age of MR patients was(61.90±15.05) years, and the male-to-female ratio was 1: 1.5. A total of 31, 495 MR patients were detected, with a detection rate of 20.97%, and the prevalence of mild(1+), moderate(2+), moderate-severe(3+) and severe(4+) were 13.73%, 2.9%, 0.46% and 0.56%, respectively, and the prevalence increased with age. The prevalence of 1+ MR was higher in females than males in all age groups(P < 0.001). Among different ethnic groups, the proportion of Uyghur regurgitation above 3+ is the largest, and the proportion of Han nationality is the lowest. Whether for degenerative MR(DMR) or functional MR(FMR), left atrial anterior-posterior diameter(LAD), left ventricular end-diastolic diameter(LVDD), left ventricular end-systolic diameter(LVSD) and left ventricular ejection fraction(LVEF) were all correlated with the severity of MR(all P < 0.001), in which the proportion of MR above 3+ increased with the decrease of LVEF and the increase of LVSD and LAD. Among the 1 501 MR patients with 3+ or above, 531(35.38%) had FMR, 227(15.12%) had rheumatic heart disease, 33(2.20%) had infective endocarditis, and 599(39.91%) had valvular degeneration. Conclusion MR has a high incidence and is a common heart valve disease. There is a difference in prevalence between males and females. Different ethnic groups also have different pathogenesis, which may be due to differences in genetic polymorphisms and pathogenic factors. With the decrease of LVEF and the increase of LVSD, patients are more likely to develop MR of 3+ and above. Patients with primary cardiac disease and valve degeneration are more likely to develop severe MR.
-
Key words:
- mitral valve regurgitation /
- epidemiology /
- clinical features
-
-
表 1 MR患病人群基线数据
Table 1. General data
X±S, 例(%) 变量 轻度(1+)(25 223例) 中度(2+)(4 771例) 中重度(3+)(688例) 重度(4+)(813例) t/χ2 P值 左心房内径/mm 36.58±5.97 44.23±7.3 48.63±8.17 51.59±8.62 3 827.274 ＜0.001 左心室舒张末内径/mm 48.61±5.15 56.08±9.48 59.76±9.33 63.36±9.45 3 688.730 ＜0.001 左心室收缩末内径/mm 32.39±5.05 40.66±10.74 43.27±10.78 45.98±10.68 3 467.094 ＜0.001 左室射血分数/% 61.7±5.97 53.22±12.27 52.75±13.24 52.11±13.34 2 112.464 ＜0.001 年龄/岁 62.94±14.93 58.76±14.72 55.8±14.49 53.44±14.56 237.684 ＜0.001 性别 627.847 ＜0.001 男 9 226(73.26) 2 504(19.88) 378(3.00) 485(3.85) 女 15 997(84.63) 2 267(11.99) 310(1.64) 328(1.74) 年龄 723.858 ＜0.001 18~34岁 1 503(75.95) 323(16.32) 64(3.23) 89(4.50) 35~54岁 4 994(71.06) 1 466(20.86) 243(3.46) 325(4.62) 55~74岁 12 619(81.34) 2 239(14.43) 316(2.04) 339(2.19) ≥75岁 6 107(87.56) 743(10.65) 65(0.93) 60(0.86) 民族 293.409 ＜0.001 汉族 14 906(83.00) 2 415(13.45) 302(1.68) 337(1.88) 维吾尔族 6 794(75.13) 1 628(18.00) 276(3.05) 345(3.82) 哈萨克族 1 568(77.59) 340(16.82) 39(1.93) 74(3.66) 回族 1 087(78.20) 230(16.55) 41(2.95) 32(2.30) 其他民族 868(80.30) 158(14.62) 30(2.78) 25(2.31) MR类型 3 293.199 ＜0.001 DMR 22 582(85.79) 2 792(10.61) 420(1.60) 528(2.01) FMR 2 641(51.05) 1 979(38.26) 268(5.18) 285(5.51) 
下载: 导出CSV
表 2 不同年龄不同性别组MR严重程度患病率
Table 2. Prevalence of MR Severity in different age and gender
例(%) 年龄 正常(118 695例) 轻度(1+)(25 223例) 中度(2+)(4 771例) 中重度(3+)(688例) 重度(4+)(813例) 组间统计检验量 P值 总统计检验量 P值 18~34岁 138.069 ＜0.001 男 6 003(90.80) 396(5.99) 144(2.18) 27(0.41) 41(0.62) 女 8 368(85.92) 1 107(11.37) 179(1.84) 37(0.38) 48(0.49) 35~54岁 2 202.891 ＜0.001 男 27 601(90.39) 1 776(5.82) 802(2.63) 151(0.49) 206(0.67) 女 12 574(75.44) 3 218(19.31) 664(3.98) 92(0.55) 119(0.71) 55~74岁 3 979.189 ＜0.001 男 33 678(84.54) 4 627(11.61) 1 169(2.93) 167(0.42) 197(0.49) 女 16 545(63.89) 7 992(30.86) 1 070(4.13) 149(0.58) 142(0.55) ≥75岁 465.963 ＜0.001 男 7 822(73.02) 2 427(22.66) 389(3.63) 33(0.31) 41(0.38) 女 6 104(59.91) 3 680(36.12) 354(3.47) 32(0.31) 19(0.19) 6 177.398 ＜0.001
下载: 导出CSV
表 3 不同民族不同年龄组MR严重程度构成比
Table 3. Composition ratio of MR Severity in different ethnic and different age
例(%) 民族 轻度(1+)(25 223例) 中度(2+)(4 771例) 中重度(3+)(688例) 重度(4+)(813例) 组间统计检验量 P值 总统计检验量 P值 汉族 336.562 ＜0.001 18~34岁 697(81.90) 122(14.34) 16(1.88) 16(1.88) 35~54岁 2 241(73.38) 599(19.61) 89(2.91) 125(4.09) 55~74岁 7 072(83.36) 1 118(13.18) 143(1.69) 151(1.78) ≥75岁 4 896(87.88) 576(10.34) 54(0.97) 45(0.81) 维吾尔族 203.240 ＜0.001 18~34岁 541(68.48) 150(18.99) 37(4.68) 62(7.85) 35~54岁 1 937(68.45) 639(22.58) 106(3.75) 148(5.23) 55~74岁 3 650(78.46) 752(16.17) 125(2.69) 125(2.69) ≥75岁 666(86.38) 87(11.28) 8(1.04) 10(1.30) 哈萨克族 22.466 0.008 18~34岁 110(78.01) 23(16.31) 4(2.84) 4(2.84) 35~54岁 422(71.89) 119(20.27) 16(2.73) 30(5.11) 55~74岁 854(79.15) 171(15.85) 17(1.58) 37(3.43) ≥75岁 182(85.05) 27(12.62) 2(0.93) 3(1.40) 回族 39.402 ＜0.001 18~34岁 69(76.67) 14(15.56) 3(3.33) 4(4.44) 35~54岁 178(67.68) 57(21.67) 16(6.08) 12(4.56) 55~74岁 621(79.11) 129(16.43) 21(2.68) 14(1.78) ≥75岁 219(86.90) 30(11.90) 1(0.40) 2(0.79) 其他民族 24.582 0.003 18~34岁 86(80.37) 14(13.08) 4(3.74) 3(2.80) 35~54岁 216(73.47) 52(17.69) 16(5.44) 10(3.40) 55~74岁 422(82.26) 69(13.45) 10(1.95) 12(2.34) ≥75岁 144(86.23) 23(13.77) 0(0) 0(0) 723.858 ＜0.001
下载: 导出CSV
-
[1] Marciniak A, Glover K, Sharma R. Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK[J]. BMJ Open, 2017, 7(1): e012240. doi: 10.1136/bmjopen-2016-012240
[2] Hu P, Liu XB, Liang J, et al. A hospital-based survey of patients with severe valvular heart disease in China[J]. Int J Cardiol, 2017, 231: 244-247. doi: 10.1016/j.ijcard.2016.11.301
[3] 《中国心血管健康与疾病报告》编写组. 《中国心血管健康与疾病报告2021》概述[J]. 中国心血管病研究, 2022, 20(7): 577-96. doi: 10.3969/j.issn.1672-5301.2022.07.001
[4] 叶蕴青, 许海燕, 李喆, 等. 中国不同区域老年瓣膜性心脏病构成和病因分析[J]. 中华老年心脑血管病杂志, 2019, 21(7): 676-682. https://www.cnki.com.cn/Article/CJFDTOTAL-LNXG201907002.htm
[5] Monteagudo Ruiz JM, Galderisi M, Buonauro A, et al. Overview of mitral regurgitation in Europe: results from the European Registry of mitral regurgitation(EuMiClip)[J]. Eur Heart J Cardiovasc Imaging, 2018, 19(5): 503-507. doi: 10.1093/ehjci/jey011
[6] Bozkurt B, Coats A, Tsutsui H, et al. Universal definition and classification of heart failure[J]. Eur J Heart Fail, 2021, 23(3): 352-380. doi: 10.1002/ejhf.2115
[7] Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial functional mitral regurgitation: JACC review topic of the week[J]. J Am Coll Cardiol, 2019, 73(19): 2465-2476. doi: 10.1016/j.jacc.2019.02.061
[8] 宋光远, 刘然, 卢志南, 等. 功能性二尖瓣反流的治疗策略[J]. 临床心血管病杂志, 2022, 38(6): 433-438. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.06.002
[9] 中华医学会心血管病学分会心血管影像学组, 北京医学会心血管病学会影像学组. 中国成人心脏瓣膜病超声心动图规范化检查专家共识[J]. 中国循环杂志, 2021, 36(2): 109-125. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202102003.htm
[10] Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults[J]. J Am Soc Echocardiogr, 2015, 28(1): 1-39. e14. doi: 10.1016/j.echo.2014.10.003
[11] Li J, Pan W, Yin Y, et al. Prevalence and correlates of mitral regurgitation in the current era: an echocardiography study of a Chinese patient population[J]. Acta Cardiol, 2016, 71(1): 55-60. doi: 10.1080/AC.71.1.3132098
[12] Jones EC, Devereux RB, Roman MJ, et al. Prevalence and correlates of mitral regurgitation in a population-based sample(the Strong Heart Study)[J]. Am J Cardiol, 2001, 87(3): 298-304. doi: 10.1016/S0002-9149(00)01362-X
[13] Stefano G, Fox K, Schluchter M, et al. Prevalence of unsuspected and significant mitral and aortic regurgitation[J]. J Am Soc Echocardiogr, 2008, 21(1): 38-42. doi: 10.1016/j.echo.2007.05.006
[14] 安勇. 新疆地区不同民族心脏瓣膜病流行病学研究[D], 2012.
[15] 王永涛. IL-10及apo-B基因多态性与心脏瓣膜钙化的相关性研究[D], 2016.
[16] Arora S, Sivaraj K, Hendrickson M, et al. Prevalence and prognostic significance of mitral regurgitation in acute decompensated heart failure: The ARIC Study[J]. JACC Heart Fail, 2021, 9(3): 179-189. doi: 10.1016/j.jchf.2020.09.015
[17] Kajimoto K, Sato N, Takano T, et al. Functional mitral regurgitation at discharge and outcomes in patients hospitalized for acute decompensated heart failure with a preserved or reduced ejection fraction[J]. Eur J Heart Fail, 2016, 18(8): 1051-1059. doi: 10.1002/ejhf.562
[18] 聂静雨. 我国35岁及以上人群二尖瓣、主动脉瓣瓣膜病患病率及影响因素分析[D], 2017.
[19] Goel SS, Bajaj N, Aggarwal B, et al. Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure: comprehensive analysis to determine the potential role of MitraClip for this unmet need[J]. J Am Coll Cardiol, 2014, 63(2): 185-186. doi: 10.1016/j.jacc.2013.08.723
-
计量
- 文章访问数: 196
- 施引文献: 0