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目的探讨中国人肥厚型心肌病(hypertrophic cardiomyopathy,HCM)的临床表现及住院转归。方法回顾性分析1999年6月至2006年3月我院收治的234例HCM患者的临床症状、体征,心电图(EKG)、超声心动图(UCG)、左心室及冠状动脉造影、治疗措施及住院转归。结果男158例、女76例,发病年龄为(51±16)岁、且女性[(54±17)岁]高于男性[(49±15)岁, P=0．028],女性心房颤动发病率为32．9％,高于男性的14．6％(p<0．05);全部患者中,有HCM家族史者30例(12．8％),有猝死家族史者8例(3．4％),NYHA分级Ⅰ-Ⅱ级者216例(92．3％)、Ⅲ-Ⅳ级者18例(7．7％)。93．6％患者临床症状为胸闷、胸痛、心悸、气促、晕厥或黑矇、头晕等,无特异性,仅15例(6．4％)患者无临床症状,体检时诊断出该病;93．6％患者EKG表现为非特异性ST-T改变,肥厚累及心尖部者胸前导联见巨大倒置T波,仅15例(6．4％)患者EKG无异常;超声心动图示,梗阻性HCM者30例(13．0%),心尖肥厚型心肌病(AHCM)57例(24．9％),肥厚累及右室6例,心室壁平均厚度为(19．5±4．6)mm。冠状动脉造影>75％的狭窄者16例(15．5％)。接受β-受体阻滞剂和(或)非二氢吡啶类钙离子拮抗剂(CCB)治疗者194例(82．9％),起搏器植入者18例,经皮化学消融者6例,左室流出道疏通术5例。院内猝死5例,其中3例经电复率或药物复率后存活,2例抢救无效死亡。结论中国HCM的发病年龄较国外偏大,临床表现无特异性;女性比男性发病年龄偏大,且更易发生心房颤动;AHCM约占1／4,男性多于女性;绝大多数患者以药物治疗为主,住院转归良好。
Objective To investigate the clinical manifestations and hospitalization of hypertrophic cardiomyopathy (HCM) in Chinese. Methods The clinical symptoms, signs, electrocardiogram (EKG), echocardiography (UCG), left ventricular and coronary angiography, treatment and hospitalization of 234 HCM patients admitted to our hospital from June 1999 to March 2006 were retrospectively analyzed. Go. Results There were 158 males and 76 females with a mean age of onset of (51 ± 16) years, and were significantly higher in women (54 ± 17 years) than in men (49 ± 15 years, P = 0.028) The incidence was 32.9%, higher than that of males (14.6%) (p <0.05). Among all the patients, there were 30 cases (12.8%) with family history of HCM and 8 cases with family history of sudden death 3.4%), 216 patients (92.3%) with NYHA grade Ⅰ-Ⅱ and 18 patients (7.7%) with Ⅲ-Ⅳ grade. Clinical symptoms of 93.6% of the patients were chest tightness, chest pain, heart palpitations, shortness of breath, fainting or darkness, dizziness, etc. There was no clinical symptom in 15 (6.4%) patients and the disease was diagnosed at the time of examination. In 93.6% of patients, EKG showed nonspecific ST-T changes. Hypertrophic involvement of the apex was seen in the inverted T wave of the chest. EKG was abnormal in only 15 patients (6.4%). Echocardiography showed obstruction There were 30 cases (13.0%) with HCM, 57 cases (24.9%) with apical hypertrophic cardiomyopathy (AHCM), 6 cases with hypertrophy involving the right ventricle and 19.5 ± 4.6% mm. Coronary angiography> 75% of the stenosis in 16 cases (15.5%). Ninety-four patients (82.9%) received β-blockers and / or non-dihydropyridine calcium channel blockers (CCB), 18 received pacemaker implants, and 6 received percutaneous chemoembolization Cases, left ventricular outflow tract dredging in 5 cases. 5 cases of sudden death in the hospital, of which 3 cases survived by electrical repolarization or drug reassignment, two died of rescue ineffective. Conclusions The age of onset of HCM in China is larger than that of other countries and the clinical manifestations are nonspecific. The age of onset of HCM in men is higher than that of men and is more likely to occur atrial fibrillation. AHCM accounts for about 1/4 of men and women are more than women. Most of the patients are treated with drugs Mainly, good hospitalization.