肺心病伴发冠心病18例病理与临床对比分析

经尸检证实肺心病伴发冠心病１８例，与单纯肺心病３０例对照，结果两组在心脏重量、右室厚度及左室厚度上差异无显著性（Ｐ＞０．０５），表明肺心病晚期也可累及左室，不管是否合并左室疾患。本组临床诊断正确率为３３．３％，漏诊冠心病为３８．９％，漏诊肺心病为２７．８％。临床单因素分析以年龄、高血压史、心绞痛史、心肌梗塞史、Ａ＿２＞Ｐ＿２、束支传导阻滞、异常Ｑ波、心电轴左偏或正常、程显声诊断标准和Ｓｅｌｖｅｓｔｅｒ心梗筛选标准对诊断伴发冠心病有显著意义（Ｐ＜０．０５）。多元前进法逐步回归分析表明心绞痛史、Ｓｅｌｖｅｓｔｅｒ心梗筛选标准和程显声标准为独立预告因子（Ｐ＜０．０３和０．０００）。上述结果缺乏特异性诊断方法，及早做冠脉造影可能是最佳选择。

A CLINICOPATHOLOGICAL STUDY OF COR PULMONALE WITH CORONARY HEART DISEASE

he necropsy findings of 18 patients with cor pulmonale and coronary heart disease (CHD) were com-pared with those of a control group of 30 patients with cor pulmonale alone. The results showed that there was no significant statistical difference between the two groups on average heart weight and average left and right ventricular thickness(P>0. 05).The results suggest that at the end stage of cor pulmonale left ventricule may be involved whether there are complicating left ventricular disease or not.In this study,cor pulmonale and CHD were both accurately diagnosed in 33.3%, CHD falied to be diagnosed in 38.9%and cor pulmonale failed to be diagnosed in 27.8% of the patients.Single diagnostic factor analysis for cor pulmonale with CHD indicated that age, history of hyperten-sion, history of angina pectoris, history of MI,accentuation A2,presence of bundle branch block, abnor-mal Q wave and left axis or normal deviation Cheng Xiansheng diagostic criteria and Selvester MI scree-ning criteria are of significance(P<0.05).Multiple factor logistic regression analysis indicated that inde-pendent prognostic factors including history of angina pectoris, Selvester MI screening criteria and Cheng Xiansheng diagnostic criteria are of help for diagnosls (P<0.03-0. 000).The above-mentioned diagnostic methods are,however, not so specific. At present the best method for diagnosis of CHD is coronary arteriography.