2018 年第 5 期 第 13 卷

老年瓣膜性心脏病合并冠状动脉粥样硬化性心脏病患者的临床特点和危险因素及治疗现状分析

Clinical characteristics, risk factors and treatment strategies of valvular heart disease with coronary atherosclerotic heart disease in elderly patients

作者：刘妍杜俣赵坤徐影影傅明洁马越王德广张敬林陈倬刘巍赵迎新周玉杰

英文作者：

单位：100029首都医科大学附属北京安贞医院心内十二病房

英文单位：

关键词：瓣膜性心脏病冠状动脉疾病临床特点危险因素治疗策略

英文关键词：

• 摘要：

• 目的    探讨老年瓣膜性心脏病（VHD）合并冠状动脉粥样硬化性心脏病（冠心病）患者的临床特点，分析老年VHD患者合并冠心病的危险因素及治疗现状。方法    连续入选2016年9—12月于首都医科大学附属北京安贞医院诊断为中重度VHD的老年住院患者800例。根据冠状动脉造影和冠状动脉CT血管成像结果将入选患者分为冠心病组（408例）与非冠心病组（392例）。比较2组临床特点的差异，分析老年VHD伴发冠心病的危险因素及治疗现状。结果    老年中重度VHD患者最常见的瓣膜病类型为二尖瓣关闭不全（262例，32.7%），其次为合并2种及以上瓣膜病（244例，30.5%）。冠心病组男性、吸烟及合并高血压、高脂血症、糖尿病、外周动脉疾病比例均明显高于非冠心病组，左心室射血分数明显低于非冠心病组（均P＜0.01）。老年VHD患者伴发冠心病的独立危险因素包括男性、吸烟史、高脂血症、糖尿病及外周动脉疾病（均P＜0.05）。冠心病组患者瓣膜手术比例明显低于非冠心病组［14.2%（58/408）比45.9%（180/392）］（P＜0.01）。结论    老年中重度VHD以二尖瓣关闭不全及合并2种及以上瓣膜病为常见。约一半的老年中重度VHD患者合并冠心病，其独立危险因素包括男性、吸烟史、高脂血症、糖尿病及外周动脉疾病。超过一半的老年VHD患者采用药物保守治疗，合并冠心病患者行瓣膜手术比例较低。

• 【Abstract】Objective    To analyze the clinical characteristics of coronary atherosclerotic heart disease（CHD） in elderly patients with valvular heart disease（VHD）; to analyze the risk factors and treatment strategies of CHD. Methods    A total of 800 consecutive elderly patients with moderate to severe VHD were screened by coronary angiography and coronary CT angiography from September to December 2016 in Beijing Anzhen Hospital, Capital Medical University. According to the imaging results, the patients were divided into CHD group(n=408) and non-CHD group(n=392). Clinical features, risk factors and treatment strategies were analyzed. Results    The most common type of VHD was mitral insufficiency(n=262, 32.7%); 244 patients（30.5%） had combination of two and more types of VHD. Ratios of male, smoking, hypertension, hyperlipidemia, diabetes, peripheral artery disease in CHD group were significantly higher than those in non-CHD group（P＜0.01）. Independent risk factors of CHD in VHD elderly patients included male, smoking history, hyperlipidemia, diabetes and peripheral artery disease（P＜0.01）. Valvular surgery ratio in CHD group were significantly lower than that in non-CHD group［14.2%（58/408） vs 45.9%（180/392）］（P＜0.01）. Conclusions    Combination of two and more types of VHD is more common in elderly patients. About half of elderly patients with moderate to severe VHD suffered CHD; the risk factors include male, smoking, hyperlipidemia, diabetes and peripheral artery disease. More than half of elderly VHD patients are treated with medication; the ratio of valve surgery is low in patients with CAD.

  【Key words】Valvular heart disease；Coronary heart disease；Clinical characteristics；Risk factors；Treatment strategies

  【Fund program】National Key Research and Development Program of China（2017YFC0908800）； "Dengfeng" Talent Training Project of Beijing Municipal Administration of Hospitals（DFL20150601）； "Shiming" Talent Project of Beijing Municipal Administration of Hospitals（SML20180601）