肝细胞癌患者IL-18基因-137G/C和-607A/C位点单核苷酸多态性变化及其意义探讨

目的探讨肝细胞癌(HCC)患者白细胞介素-18(IL-18)基因-137G/C和-607A/C位点单核苷酸多态性(SNP)的变化。方法在178例伴有HBV感染的HCC患者和251例健康人,取外周静脉血提取DNA,采用聚合酶链反应-连接酶检测反应(PCR-LDR)行基因分型,测定IL-18基因-137G/C和-607A/C位点SNP。结果 HCC患者和健康人IL-18-37 G/C基因GG基因型、GC基因型和CC基因型分布频率分别为75.3%对47.0%(P0.05)、20.8%对51.4%(P0.05)和3.9%对1.6%(P0.05),G等位基因和C等位基因分布频率分别为93.6%对72.7%(P0.05)和6.4%对27.3%(P0.05);HCC患者和健康人IL-18-607A/C位点AA基因型、AC基因型和CC基因型分布频率分别为37.6%对13.5%(P0.05)、43.3%对66.9%(P0.05)和19.1%对19.5%(P0.05),A等位基因和C等位基因分布频率分别59.3%对47.0%(P0.05)和40.7%对53.0%(P0.05);HCC组IL-18-137G/C位点的GG基因和G等位基因频率显著高于健康人(P0.05),HCC组IL-18-607A/C位点的AA基因和A等位基因频率也显著高于健康人(P0.05),提示携带IL-18-137G/C和IL-18-607A/C位点基因型和A等位基因者罹患HCC的风险增加。结论携带IL-18基因-137G/C位点GG基因型和G等位基因以及-607A/C位点AA基因型和A等位基因者可能更容易发生HCC,对HBV感染者筛查这些基因可能有助于早期发现肝肿瘤,以利于早期处理和改善预后。     

新疆哈萨克族CETP基因多态性与血脂及高脂血症中医证型的关系

目的探讨新疆哈萨克族CETP基因A373P、c.*84GA位点多态性与血脂水平及高脂血症中医证型的关系。方法采用中医症候问卷调查的方法四诊合参对高脂血症病人中医辨证分型,应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法对448例研究对象进行抽血检测血脂及基因分型分析。结果 (1)共检出胆固醇酯转移蛋白(CETP基因)的2个位点3种基因型AA、AG、GG,以GG基因型频率最高,新疆哈萨克族高脂血症组中c.*84GA位点AA、AG和GG基因型频率分别为0例、11例和207例;高脂血症组中C和G的等位基因频率分别为2.5%和97.5%,健康对照组中C和G的等位基因频率分别为3.7%和96.3%。(2)新疆哈萨克族CETP基因A373P基因型高脂血症组和健康对照组之间血浆总胆固醇(TC)有统计学意义(P 0.05)。A373P位点高脂血症中G等位基因携带者(AG、GG基因型)较非G等位基因携带者(AA基因型)有更高的血浆TC和水平(P 0.05);(3)A373P位点GG基因型中痰浊阻遏证最多有70例;其次为肝肾阴虚和脾肾阳虚。AG基因型中痰浊阻遏最多16例。AA基因型所有证型都很少,脾肾阳虚2例,痰浊阻遏1例。进一步统计学分析表明在GG、AA、AG基因型构成比中存在差异,痰浊阻遏高于肝肾阴虚,肝肾阴虚高于脾肾阳虚,脾肾阳虚高于气滞血瘀,气滞血瘀高于阴虚阳亢。结论新疆哈萨克族转脂蛋白基因A373P、c.*84GA多态性与高脂血症水平可能无相关,A373P基因型GG与高脂血症痰瘀互阻可能相关。     

慢加急性乙型肝炎肝衰竭患者外周血IFN-γ基因多态性分析及其临床意义探讨

目的探讨乙型肝炎病毒感染引起的慢加急性肝衰竭患者血IFN-γ基因多态性。方法采用单核苷酸多态性(SNP)技术检测51例ACLF患者和50例健康人血IFN-γ基因内含子+874位点T/A和+2109位点A/G单核苷酸多态性。结果 ACLF患者+874位点TA+AA基因型频率(54.9%)显著高于健康人(24.0%),A等位基因频率(38.2%)显著高于健康人(22.0%,P0.05);ACLF组+2109位点AG+GG型基因型频率(51.0%)显著高于健康人(26.0%),G等位基因(32.4%)显著高于健康人(16.0%,P0.05);在3 m末,28例生存与23例死亡的ACLF患者+874、+2109位点等位基因和基因型频率分布无显著性差异(P0.05)。结论 IFN-γ基因+874位点A等位基因和基因型、+2109位点G等位基因和基因型是ACLF的遗传易感基因。     

尾加压素Ⅱ基因多态性与多囊卵巢综合征相关性的研究

目的 探讨尾加压素Ⅱ(UTS2)基因多态性与多囊卵巢综合征(PCOS)发病的关系.方法 用熔解温度不同的基因分型法.检测PCOS患者101例(PCOS组)及其父母202名和105名健康妇女(对照组)UTS2基因rs228648、rs2890565位点单核苷酸多态性(SNP),并检测基础状态下FSH、LH、睾酮、空腹血糖、空腹胰岛素水平.结果 PCOS组的UTS2基因rs228648 A/G多态性位点与对照组比较,基因型与等位基因频率均无明显差异,两组的SNP rs2890565基因型频率差异有统计学意义(P<0.05),PCOS组A等位基因频率明显高于对照组(P<0.05).传递不平衡检验(TDT)显示,SNP rs228648A/G在杂合子父母的2个不同等位基因无优势传递(P>0.05),而rs2890565 A/G在杂合子父母A等位基因优势传递(P<0.05).PCOS组UTS2基因SNP rs228648 GG基因型较携带A等位基因的PCOS患者稳态模型评估的胰岛素抵抗指数(HOMA-IR)明显增高(P<0.05).SNP rs2890565从和AG基因型空腹血糖、空腹胰岛素较GG基因型明显增高,从基因型HOMA-IR较GG基因型明显增高(P<0.05).结论 UTS2基因SNP rs228648 A/G多态性与PCOS无相关性,但与胰岛素抵抗存在关联.UTS2基因SNP rs2890565可能在PCOS的遗传易感性中起一定作用,A等位基因可能与PCOS的发生有关.     

IL-17A基因多态性及血浆水平与病毒性心肌炎的相关性研究

目的:探讨白细胞介素17A(interleukin-17A,IL-17A)rs2275913(G-197A)位点单核苷酸多态性(single nucleotide polymorphisms,SNPs)及血浆水平与重庆汉族人群病毒性心肌炎(viral myocarditis,VMC)的关系。方法:收集VMC患者200例,根据病程将患者分为急性期组112例和恢复期组88例,并选择同期200例健康体检的正常人作为对照组,采用聚和酶链反应-限制性内切酶片断长度多态性(PCR-RFLP)、DNA测序等方法检测全部受试者IL-17A基因rs2275913(G-197A)位点SNP,采用酶联免疫吸附法(ELISA)测定两组血清IL-17水平。结果:VMC组IL-17A基因rs2275913(G-197A)多态位点AA基因型和A等位基因频率均显著高于对照组(P0.05),携带AA基因型及携带A等位基因(AA+AG基因型)可增加患VMC的易感性(矫正后ORAA=2.197,95%CIAA=1.208-4.279,PAA=0.003;矫正后ORAA+AG=2.051,95%CIAA+AG=1.134-3.995,PAA+AG=0.009)。VMC组血清IL-17水平明显高于对照组(P0.05),尤以急性期为著(P0.05)。不论是VMC组还是对照组,IL-17A基因rs2275913(G-197A)多态位点中含A等位基因(AA+AG)者血清IL-17水平均显著高于非A等位基因(GG)携带者(P0.01)。结论:IL-17A基因rs2275913位点SNP可能与中国重庆地区汉族人群VMC有关,A等位基因是VMC的易感基因。     

细胞毒T淋巴细胞抗原4基因多态性与肝癌易感性的相关性

目的探讨细胞毒T淋巴细胞抗原4(CTLA-4)基因多态性与肝癌易感性的相关性。方法选择陕西省安康市中心医院2016年1月-2018年12月收治的70例肝癌患者,另以70例健康体检者作为对照。所有患者均检测CTLA-4基因外显子49位点的基因型分布。比较2组AA、AG、GG基因型分布与等位基因A、G的基因频率。采用Spearman相关性分析基因型分布与肝癌易感性之间的相关性,并进一步进行基因频率相对风险分析。结果 2组AA、AG、GG基因型的分布存在显著差异,肝癌患者均GG基因型居多,对照组以AG基因型居多(P0.001)。肝癌组G等位基因频率为71.43%,显著高于对照组51.43%(P0.05)。CTLA-4基因多态性与肝癌易感性之间存在明显相关性(r=0.701,P=0.012),携带G等位基因会增加肝癌患病风险[OR=4.101(2.227～10.031)]。结论 CTLA-4基因的外显子49位点基因多态性与肝癌易感性存在较大相关性,携带G等位基因的肝癌患病风险相对更大。     

老年高血压并抑郁症与血管紧张素原G-6A位点基因多态性的相关性研究

目的探讨老年高血压并抑郁症与血管紧张素原(AGT)基因G-6A位点基因多态性的关系。方法选择2010年12月—2013年11月昆明市延安医院干疗/老年病科及云南省精神病院收治的老年高血压患者400例,根据患者是否并发抑郁症分为高血压并抑郁症组和高血压组,各200例;另选取同期就诊于昆明市延安医院体检中心的200例老年体检健康者作为健康对照组。采用基因测序方法检测AGT基因G-6A位点基因多态性。结果 (1)高血压并抑郁症组和高血压组AGT基因G-6A位点G/G基因型所占比例高于健康对照组、A/A基因型所占比例低于健康对照组,高血压并抑郁症组AGT基因G-6A位点GG基因型所占比例高于高血压组(P0.05)。(2)高血压并抑郁症组和高血压组等位基因频率分布分别与健康对照组比较,差异有统计学意义(P0.05),OR(95%CI)分别为3.389(2.475,4.651)、2.336(1.698,3.215);高血压并抑郁症组和高血压组等位基因频率分布比较,差异有统计学意义(P0.05),OR(95%CI)为1.452(1.094,1.928)。结论 AGT基因G-6A位点基因多态性与老年高血压并抑郁症遗传易患性有关,携带AGT基因G-6A位点G/G基因型及G等位基因的高血压患者患抑郁症的风险较高,携带AGT基因G-6A位点A/A基因型及A等位基因的人群患高血压及高血压并抑郁症的风险较低。     

阻塞性睡眠呼吸暂停低通气综合征与5-羟色胺2A受体A1438G基因多态性相关

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发生与5-羟色胺(5-HT)2A受体A1438G基因多态性的相关性.方法 采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,对无亲缘关系的汉族76例OSAHS患者及54名正常对照者5-HT 2A受体A1438G位点的基因多态性进行检测,比较两组基因型分布及等位基因频率的差异,分析基因型对OSAHS患者多导睡眠图(PSG)参数及肥胖指标的影响.结果 ①OSAHS组5-HT 2A受体A1438G位点的AA基因型及A等位基因频率显著高于对照组(2=17.139,P=0.002;2=27.785,P=0.001).②AA型比AG、GG型病情更重,但肥胖相关指标差异却无统计学意义(P均＞0.05).③与AG、GG型比较,AA型患者一级亲属中OSAHS的发病率更高(分别为24.5%、12.3%、34.7%).结论 5-HT 2A受体A1438G基因多态性与汉族OSAHS的发病可能有关,A等位基因可能是一易感基因,但它可能并不是通过中心性肥胖、颈部脂肪增加的途径导致OSAHS的发生.     

内皮素-2基因多态性与老年原发性高血压发生及非洛地平降压作用的关系

目的探讨内皮素-2基因多态性与老年原发性高血压及降压治疗效果的关系。方法汉族老年原发性高血压患者200例作为高血压组,健康体检老年人200例作为对照组。高血压患者给予非洛地平(5 mg,1次/d)口服治疗2个月。采用基因芯片技术测定内皮素-2基因A985G位点基因型。结果高血压组和对照组内皮素-2基因A985G位点基因型比较差异有统计学意义(P0.05),高血压组GG基因型高于对照组(P0.05),AA基因型和AG基因型低于对照组(P0.05)。高血压组和对照组内皮素-2基因A985G位点等位基因频率比较差异有统计学意义(P0.05),高血压组G等位基因频率高于对照组,A等位基因频率低于对照组(P0.05)。高血压组高血压家族史比例高于对照组(P0.05),体重指数、总胆固醇和三酰甘油水平均高于对照组(P0.05)。高血压患者治疗后收缩压和舒张压均明显低于治疗前(P0.05),GG基因型收缩压和舒张压下降值高于AA基因型和AG基因型(P0.05),AG基因型收缩压和舒张压下降值高于AA基因型(P0.05)。结论内皮素-2基因A985G位点基因多态性和老年原发性高血压的发病有关,应用非洛地平降压治疗后,GG基因型的降压效果更好。     

白细胞介素-1F7基因单核苷酸多态性对强直性脊柱炎易感性与病情的影响

目的 探讨白细胞介素(IL)-1F7基因rs3811047位点单核苷酸多态性(SNP)对强直性脊柱炎(AS)易感性和临床表现型的影响.方法 收集AS患者158例和同期健康献血人群181名,采用连接酶检测反应(LDR-PCR)方法检测IL-1F7基因rs3811047位点SNP,分析其等位基因频率及基因型频率在AS和对照组中的分布,并比较不同基因型AS患者间临床表现型的差别.结果 AS患者和对照人群中rs3811047位点A等位基因频率(12.03%,17.68%)和G等位基因频率(87.97%,82.32%)的分布差异有统计学意义(x2=4.2204,P=0.0399);AA,AG,GG基因型频率在AS中分别为0,24.05%,75.95%,与对照组分布(2.76%,29.83%,67.41%)相比,差异亦有统计学意义(x2=6.2675,P=0.043).AG基因型的AS患者中人类白细胞抗原(HLA)-B27阳性率为70.27%(26/37),明显低于GG基因型AS中HLA-B27的阳性率94.23%(98/104),差异有统计学意义(x2=2.168,P=0.030);其红细胞沉降率和C反应蛋白水平明显亦低于GG基因型组(t=2.971,P=0.013;t=3.300,P=0.001).结论 安徽籍汉族人群AS易感性与IL-1F7基因rs3811047位点SNP有关,其基因型对AS的临床表现型有影响,携带A等位基因患者的炎症表现轻于不携带A等位基因的患者.     

Angiotensinogen gene variations and LV outflow obstruction in hypertrophic cardiomyopathy

Background

Variations of angiotensinogen (AGT) gene have been associated with cardiac hypertrophy. We hypothesized that AGT gene polymorphism may play a modifier role in the diversity of left ventricular outflow obstruction.

Methods

The polymorphisms of the AGT gene were genotyped in 225 patients with hypertrophic cardiomyopathy (HCM) and 243 age-and sex-matched healthy controls. The effect of the A and G alleles on the expression of the reporter gene were evaluated in vitro using dual-luciferase reporter assays.

Results

Our results showed that the frequency of the A allele was higher in patients than in controls (50.2?% vs. 35.8?%, p?<?0.05). Patients carrying the AA and AG genotypes had a higher proportion of left ventricular outflow obstruction (30.1?% vs. 17.0?%, p?<?0.05) and heart failure (NYHA functional class III?~?IV, 35.4?% vs. 18.8?%, p?<?0.05) than those carrying the GG genotype had. After adjusted for age, sex, the thickness of the interventricular septum, family history of HCM, and sudden death, the A allele conferred a 2.4-fold risk for left ventricular outflow obstruction than the GG genotype did (adjusted OR?=?2.4, 95?%CI 1.2–4.8). The G allele suppressed the expression of the reporter gene significantly compared with the A allele (p?<?0.05).

Conclusion

AGT gene variations may be genetic modifiers for the development of HCM.     

肾素-血管紧张素系统基因多态性与原发性高血压左心室肥厚关系的探讨

目的　探讨肾素 血管紧张素系统 (RAS)基因多态性与原发性高血压左心室肥厚 (EH LVH)的相关性以及在EH LVH产生中的多基因协同作用。方法　对 10 9例原发性高血压病 (EH)患者 ,采用聚合酶链反应 (PCR)以及聚合酶链反应 限制性片段长度多态性方法检测血液白细胞染色体DNA中血管紧张素转换酶 [ACE(I D) ]、血管紧张素原 [AGT(M2 35T) ]和血管紧张素Ⅱ 1型受体 [AT1 R(A116 6C) ]基因多态性 ;利用超声心动图检测左心室质量 (LVM)并计算左心室质量指数 (LVMI)。结果　ACE(I D)基因多态性D等位基因频率在EH LVH组中明显增高 (χ2 =4 .6 9,P=0 .0 30 ) ,男性EH患者中 ,ACE(I D)基因型构成比与LVH有关联 (χ2 =9.5 5 ,P =0 .0 0 8)。协同存在AGT TT型时 ,ACE(I D)基因多态性与EH LVH有关 (χ2 =6 .2 2 ,P =0 .0 4 4 ) ,且D等位基因在EH LVH明显增高 (χ2 =6 .91,P =0 .0 0 9) ,该类EH患者发生LVH的相对危险度增高 (OR :2 .5 0 ,95 %CI:1.2 5～ 5 .0 0 )。结论　ACE(I D)基因多态性D等位基因可能是LVH的独立危险因子。ACE基因多态性与AGT基因多态性之间的协同效应表明 ,同时携带AGT TT型时 ,具有ACE(I D)基因多态性D等位基因的EH患者更易发生LVH。     

经胸超声心动图评价高血压心脏病与左心室流出道梗阻的应用价值

目的:应用经胸超声心动图(transthoracic echocardiography,TTE),评价高血压心脏病与肥厚型心肌病(HCM)左心室流出道梗阻的二维及血流动力学特征,为临床鉴别诊断提供影像学依据。方法:左心室流出道梗阻患者31例,其中高血压性左心室流出道梗阻12例,肥厚型梗阻性心肌病19例,二维图像下测量两组患者的室间隔厚度及左心室后壁厚度,在静息状态和激发试验后测量两组患者的左心室流出道流速及最大压差,分别进行组间及组内比较。结果:室间隔厚度肥厚型心肌病组(19.6±1.8)mm明显高于高血压组(12.4±0.6)mm,差异有统计学意义(P<0.05)。左心室后壁厚度:肥厚型心肌病组(11.5±0.5)mm,高血压组(11.3±0.6)mm,两组间比较差异无统计学意义(P>0.05)。高血压组组内比较激发试验后左心室流出道流速(398.6±36.7)cm/s及压差[(68.4±12.9)mmHg,1 mmHg=0.133kPa],均高于静息状态下流速178.2±23.4)cm/s,压差(13.5±6.2)mmHg,差异有统计学意义(P<0.05)。结论:经胸超声心动图能准确评价左心室流出道梗阻的解剖结构与血流动力学特征,可准确鉴别梗阻类型及梗阻程度。     

Doppler color flow mapping studies of jet formation and spatial orientation in obstructive hypertrophic cardiomyopathy

To help clarify the mechanism of outflow tract obstruction and systolic anterior motion of the anterior leaflet of the mitral valve and their relation to the geometry of the left ventricle, we studied left ventricular outflow tract flow in 20 patients with hypertrophic cardiomyopathy (HCM) using two-dimensional Doppler flow mapping. We compared our results with outflow tract flow in 10 patients with isolated valvular aortic stenosis, (AS) and with those in 10 healthy volunteers. In HCM, a 94- to 145-degree angle (mean 111.4 +/- 11.9 degrees) developed between the direction of left ventricular outflow tract flow acceleration and aortic valve outflow, resulting in posterolaterally directed left ventricular outflow jets. The angle of the outflow jet and the peak velocity of the jet measured with continuous wave Doppler (as an indicator of the severity of obstruction) correlated well (r = -0.81, SEE = 7.8 degrees). Jet narrowing during ejection measured just proximal to the point of systolic anterior motion was 42 +/- 11% in HCM and was weakly correlated with peak jet velocity (r = 0.61, SEE = 8.9 degrees). Aliasing of left ventricular outflow occurred proximal to systolic anterior motion of the mitral valve, and color M-mode demonstrated temporal and spatial flow acceleration proximal to systolic anterior motion, providing evidence for obstruction at that site. In AS, left ventricular outflow tract jets were more parallel to the axis of aortic outflow (129 to 153 degree, 138.4 +/- 8.1 degrees). Jet narrowing was only 8 +/- 5% compared to HCM (both p less than 0.05), and flow acceleration occurred proximal to the stenotic valve.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypertrophic Cardiomyopathy with Right Ventricular Outflow Tract and Left Ventricular Intracavitary Obstruction

Obstruction of the right ventricular outflow tract (RVOT) is a rare finding in hypertrophic cardiomyopathy (HCM) patients unlike left ventricular outflow tract (LVOT) obstruction. Although there are guidelines that aid in clinical decision making in patients with LVOT obstruction, there are none addressing RVOT obstruction. As RVOT obstruction may pose serious clinical implications similar to LVOT obstruction, appropriate medical and surgical management is very important. A unique phenotype of HCM with RVOT obstruction in conjunction with left ventricle (LV) intracavitary obstruction is discussed.     

肥厚型心肌病患者小动脉弹性指数水平与左心室流出道梗阻的关系

目的：探讨肥厚型心肌病（HCM）患者小动脉弹性指数（C2）水平与左心室流出道梗阻的关系. 方法：纳入2010年1月至2013年7月间因肥厚型心肌病于我院心内科住院的患者69例,收集相关临床资料,比较C2水平与相关指标的关联性.再根据左心室流出道梗阻情况的不同,将HCM患者分为梗阻性HCM与非梗阻性HCM,比较两组患者的C2水平. 结果：N末端B型利钠肽原（NT-proBNP）、左室流出道最大压差（LVOTPG）与C2呈显著负相关,左室短轴缩短率（LVFS）与C2呈显著正相关,左室后壁宽度（LVPWD）与C2无显著相关性,超敏肌钙蛋白I（c-TNI）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）与C2呈非线性相关.梗阻性HCM患者的C2水平显著低于非梗阻性HCM患者. 结论：C2与LVOTPG密切相关,该指标可作为HCM患者左心室流出道梗阻病情进展的动态评价指标.     

Clinical Analysis of 42 Patients With Hypertrophic Cardiomyopathy

Objectives To investigate the clinical manifestations of hypertrophic cardiomyopathy (HCM), and to find out the clinical clues to avoid misdiagnosis and provide reference for future clinical diagnosis and treatment. Methods A retrospective analysis of 42 consecutive patients with HCM hospitalized in our hospital between January 1995 and December 2002 was explored. Based on the family history of HCM, clinical manifestations, electrocar-diogram, echocardiogram, coronary angiography and left ventriculography, the clinical characteristics between HCM patients with left ventricular outflow tract obstruction (HOCM) and HCM patients without obstruction (HNOCM) were compared. The causes of misdiagnosis and losing diagnosis were analysis. Results 13 patients were in HOCM group and 29 patients were in HNOCM group. More patients with syncope were in HOCM group than in HNOCM group (6/13 vs. 2/29, P < 0.05). Patients with ejective murmur were in HOCM group only (P < 0.01). Left ventricular outflow tract pressure gradient (LVOTPG) only observed in HOCM group (P < 0.01). Ventricular tachycardia was seen in both groups. 28 out of 42 patients (66.67%) had misdiagnosis, and 4 out of 42 patients (9.53%) had losing diagnosis. Thus, coronary heart disease (CHD) had the highest rate of misdiagnosis. There were 20 CHD patients (71.43%) among 28 patients with misdiagnosis. Hypertension was in 3, congenital heart in 2, cerebro-embolism in 2, and myocarditis in 1. Conclusions For a patient with family history or sudden death history of HCM, unexplained syncope episodes, chest pain (angina), especially in young, an ejection murmur along the left sternum border, the presence of narrow and deep Q waves, or inversion of giant T waves in V3-V6, atrial fibrillation and /or cerebra-embolism echocardiogram should be given. CAG and LVG are necessary only if the result of echo is negative, and the patients with suspected HCM or CHD.     

Development and determinants of dynamic obstruction to left ventricular outflow in young patients with hypertrophic cardiomyopathy.

BACKGROUND. To study the development of dynamic subaortic obstruction in young patients with hypertrophic cardiomyopathy (HCM), serial echocardiograms were retrospectively analyzed in a group of 26 consecutive children with this disease who showed no evidence of dynamic outflow obstruction at their initial evaluation (age, 11 +/- 3 years). METHODS AND RESULTS. After a follow-up of 3-12 years (mean, 7 +/- 3 years), seven of the 26 patients (27%) developed echocardiographic evidence of subaortic obstruction, i.e., marked systolic anterior motion (SAM) of the mitral valve with mitral-septal apposition and increased left ventricular outflow tract systolic velocities (3.8 +/- 0.3 m/sec; range, 3.1-4.5). Patients who developed SAM had smaller transverse dimension of the left ventricular outflow tract and more anteriorly displaced mitral valve when initially evaluated than did patients without development of SAM (outflow tract dimension, 19.1 +/- 4 versus 24.6 +/- 4 mm; mitral valve position index, 1.07 +/- 0.2 versus 0.73 +/- 0.3; each p less than 0.02). In patients with development of SAM, the already reduced outflow tract dimension decreased further during follow-up, and the mitral valve became even more anteriorly displaced within the left ventricular cavity. These developmental alterations in outflow tract size were associated with increases in left ventricular wall thickness, particularly of the basal anterior septum (11.0 +/- 8 mm; 72 +/- 33%) compared with control patients with HCM who did not develop SAM (3.0 +/- 3 mm; 17 +/- 10%; p less than 0.05). CONCLUSIONS. Development of subaortic obstruction in young patients with HCM results from a process of dynamic remodeling of left ventricular geometry over several years and is characterized by progressive narrowing of the outflow tract with anterior displacement of the mitral valve and disproportionate thickening of the basal anterior ventricular septum.     

肥厚型心肌病患者发生室性心律失常的相关危险因素分析

目的探讨肥厚型心肌病（hypertrophic cardiomyopathy,HCM）患者室性心律失常发生的相关性因素及特点。方法回顾性分析95例经临床及超声心动图检查确诊的HCM患者的临床资料,并与80例无心脏病对照组进行比较。结果室性心动过速（室速）组与非室速组的晕厥发生率（61．74％vs11．76％,P〈0．05）、家族史（38．9％vs11．7％,P〈0．05）、Q-Tc间期[（448．83±28．22）msvs．（427．38±25．55）ms,P〈0．05]、T波峰-末（T—peak—end,Tp．e）间期[（108．33±6．85msvs（100．00±11．32）ms,P〈0．051、经心率校正后T波峰-末（Tp—ec）间期[（126．33±12．13）msvs（95．95±12．15）ms,P〈0．05]、射血分数（53．03％±14．31％眠71．00％±8．63％,P〈0．05）比较,差异有统计学意义。Logistic回归分析结果显示,Tp—e间期、Tp—ec间期、Q—T间期延长、左心室流出道梗vs与HCM恶性室性心律失常的发生相关。结论HCM患者的心肌结构排列紊乱和心电紊乱严重,易发生快速性心律失常。Tp—e间期、Tp—ec间期、Q—T间期延长、左心室流出道梗vs与恶性室性心律失常的发生关系密切。Tp—e间期、Tp—ec间期可能具有预测室性心律失常发生的价值。     

Left intraventricular gradients measured by Doppler echocardiography at rest, during exercise and during isoproterenol test in hypertrophic cardiomyopathy]

Doppler echocardiography has been shown to be an accurate method of assessing left ventricular outflow obstruction in hypertrophic cardiomyopathy (HCM). One of the characteristics of this pressure gradient is its variability and, therefore, we measured this parameter during dynamic exercise testing in 33 patients. The results were compared with those recorded during isoproterenol infusion, the reference stress test for patients with HCM. Submaximal exercise in the recumbent position is usually well tolerated and resulted in a 43% increase in heart rate and a 47% increase in pressure gradient. There was a significant correlation between resting and exercise outflow obstruction (r = 0.90; p = 0.001). Moreover, exercise echo revealed obstruction in 26% of patients without resting pressure gradients (latent obstruction). The interpretation of results obtained with isoproterenol infusion is more difficult: this test resulted in an important increase in the left ventricular pressure gradient (231%) and "revealed" obstruction in 84% of cases. Therefore, we believe that exercise is more physiological and better tolerated than isoproterenol stress infusion and should be adopted as the investigation of choice in HCM even without obstruction at rest. If it is not possible to perform the exercise or no outflow tract obstruction can be demonstrated, an isoproterenol infusion may be used but this is not always well tolerated and the results should be interpreted with caution.