2025 年第 7 期 第 20 卷

二尖瓣脱垂患者的临床特点及术式选择分析

Analysis of the clinical characteristics and surgical method selection of patients with mitral valve prolapse

作者：蔡雪敏李冰薛佳冯阳阳韩建成姚艳

英文作者：Cai Xuemin Li Bing Xue Jia Feng Yangyang Han Jiancheng Yao Yan

单位：首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：二尖瓣脱垂；临床特点；影响因素

英文关键词：Mitralvalveprolapse;Clinicalcharacteristics;Influencingfactors

• 摘要：

• 目的 探讨二尖瓣脱垂（MVP）患者临床特点及术式选择的相关因素。方法 收集2018年1月1日至2023年12月31日在首都医科大学附属北京安贞医院行外科手术的1 015例MVP患者临床资料进行回顾性分析。根据手术方式的不同分为成形组（662例）和置换组（353例），收集患者入院时的基线资料及经胸超声心动图的信息，比较2组患者的临床特点，并分析MVP患者术式选择的相关因素。结果 成形组患者年龄小于置换组，冠心病（冠状动脉粥样硬化性心脏病）、糖尿病、高脂血症比例低于置换组，D-二聚体、C反应蛋白（CRP）和B型脑钠肽（BNP）水平均低于置换组，估算肾小球滤过率水平高于置换组（均P<0.05）。1 015例患者中768例（75.7%）患者同时联合其他心脏手术，317例（31.2%）行病理检查、其中黏液样变性270例（85.2%）。成形组左心房内径、左心室舒张末期内径、左心室收缩末期内径小于置换组，左心室射血分数高于置换组［（45±8）mm比（47±9）mm、（56±7）mm比（57±8）mm、（36±6）mm比（38±8）mm、（63±6）%比（62±7）%］（均P<0.05）。二元Logistic逐步前向回归分析结果提示高龄、CRP较高、BNP较高是MVP患者选择置换术的独立相关因素（均P<0.05）。结论 MVP行外科手术的患者中置换组患者年龄较高，CRP、BNP较高，可能对于临床医师术式选择有参考。

• Objective  To explore the clinical characteristics of patients with mitral valve prolapse (MVP) and the related factors of surgical method selection. Methods The clinical data of 1 015 MVP patients who underwent surgical operations at Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to December 31, 2023 were collected for retrospective analysis. According to the different surgical methods, they were divided into the formation group (662 cases) and the replacement group (353 cases). The baseline data of the patients at admission and the information of transthoracic echocardiography were collected. The clinical characteristics of the two groups of patients were compared, and the related factors of the surgical method selection of MVP patients were analyzed. Results The age of patients in the formation group was younger than that in the replacement group, and the proportions of coronary atherosclerotic heart disease, diabetes mellitus, and hyperlipidemia were lower than those in the replacement group; the levels of D-dimer, C-reactive protein (CRP) and brain natriuretic peptide (BNP) were all lower than those in the replacement group, while the estimated glomerular filtration rate level was higher than that in the replacement group (all P<0.05). Among the 1 015 patients, 768 cases (75.7%) underwent combined other cardiac surgeries simultaneously, and 317 cases (31.2%) underwent pathological examinations, among which 270 cases (85.2%) had myxoid degeneration. The left atrial inner diameter, left ventricular end-diastolic inner diameter and left ventricular end-systolic inner diameter in the formation group were smaller than those in the replacement group, and the left ventricular ejection fraction was higher than that in the replacement group ［(45±8)mm vs (47±9)mm, (56±7)mm vs (57±8)mm, (36±6)mm vs (38±8)mm, (63±6)% vs (62±7)%］(all P<0.05). The results of binary Logistic stepwise forward regression analysis indicated that advanced age, higher CRP, and higher BNP were independent related factors for MVP patients to choose replacement surgery(all P<0.05). Conclusions Among the patients who underwent surgical operation for MVP, those in the replacement group are older and had higher CRP and BNP levels, which might be a reference for clinicians′ method selection on surgical methods.