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目的:比较老年二尖瓣腱索断裂(RMCT)患者与中青年RMCT患者的临床表现以及超声心动图特点,为老年RMCT患者的诊断和治疗提供依据。方法:选择年龄>60岁的老年RMCT患者53例定义为老年组,年龄<60岁的中青年RMCT患者57例定义为中青年组,使用经胸超声心动图(TTE)和经食道超声心动图(TEE)测量各组的心腔尺寸,观察二尖瓣活动形态以及腱索断裂的部位和程度,记录瓣膜的返流情况。结果:老年组中风心病仅占5.66%,而中青年组风心病患者占50.88%,差异有统计学意义(X2=27.221,P=0.000)。老年组多合并有多种慢性疾病,其中合并高血压者占83.02%,合并冠心病者占60.38%,合并2型糖尿病者占37.74%,均高于中青年组,其中合并高血压的差异有统计学意义(X2=31.459,P=0.000)。老年组中心功能Ⅳ级的比例远高于中青年组,差异有统计学意义(X2=10.489,P=0.001)。老年组全心扩大、肺动脉高压的例数显著高于中青年组,差异有统计学意义(全心扩大:X2=11.376,P=0.001;肺动脉高压:X2=20.362,P=0.000)。老年组中二尖瓣细小腱索断裂的例数多于中青年组,差异有统计学意义(X2=9.799,P=0.002),粗大腱索断裂的例数少于中青年组,差异有统计学意义(X2=11.118,P=0.001)。结论:合并有高血压、冠心病以及糖尿病等基础疾病的老年RMCT患者,应定期进行超声心动图的检查,同时给予合理的治疗,以降低心衰的发病率。
Objective: To compare the clinical manifestations and echocardiographic features of elderly patients with RMCT with mitral valve rupture (RMCT) and young patients with RMCT, and to provide evidence for the diagnosis and treatment of elderly patients with RMCT. METHODS: Fifty-three elderly RMCT patients aged 60 years and older were enrolled in this study. Totally 57 young and middle-aged RMCT patients aged <60 years were defined as young and middle-aged patients. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) was used to measure the size of the heart chamber in each group. The mitral valve activity and the location and extent of the chordae tendon rupture were observed. The valvular regurgitation was recorded. Results: The incidence of stroke in the elderly group only accounted for 5.66%, while the incidence of rheumatic heart disease in the middle-aged group accounted for 50.88%. The difference was statistically significant (X2 = 27.221, P = 0.000). There were many chronic diseases in the elderly group, including 83.02% with hypertension, 60.38% with coronary heart disease, 37.74% with type 2 diabetes mellitus, which were higher than those in middle-aged group Statistical significance (X2 = 31.459, P = 0.000). The proportion of grade Ⅳ in the elderly group was much higher than that in the middle-aged group (χ2 = 10.489, P = 0.001). In the elderly group, the number of patients with pulmonary hypertension was significantly higher than that of the middle-aged and young patients. The difference was statistically significant (total heart enlargement: X2 = 11.376, P = 0.001; pulmonary hypertension: X2 = 20.362, P = 0.000). There were more cases of mitral valve tendon rupture in the elderly group than in the young and middle-aged group, the difference was statistically significant (X2 = 9.799, P = 0.002). The number of cases of coarse tendon rupture was less than that of middle-aged and young group Significance (X2 = 11.118, P = 0.001). CONCLUSIONS: Elderly RMCT patients with underlying diseases such as hypertension, coronary heart disease and diabetes mellitus should be regularly examined by echocardiography with reasonable treatment to reduce the incidence of heart failure.