比较老年与中青年二尖瓣腱索断裂的超声心动图特征和规律性

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：XZ=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。

Comparison of the Echocardiographic Characteristics and Regularity between Old and Young Patients with Rupture of Mitral Chordae Tendineae

Objective： To compare the echocardiographic characteristics between old and young patients with rupture of mitral chordae tendineae （RMCT） in order to provide the evidence for the diagnosis and treatment of the elderly RMCT patients. Methods： Fifty-three RMCT patients with age〉60 years were defined as the elder group, while 57 RMCT patients with age〈57 years were defined as the middle-aged group. The size of cardiac chamber, patterns ofmitral valve, valvular regurgitation, and the site and extent of ruptured chordae tendineae were observed and recorded with transthoracic echocardiography （TTE） and transesophageal echocardiography （TEE）. Results： The ratio of rheumatic heart disease in the elder group was only 5.66%, while that in the middle-aged group was 50.88%. The difference was statistically significant （X2 = 27.221, P = 0.000）. Many patients in the elder group were associated with a variety of chron- ic diseases. Patients with hypertension accounted for 83.02%, coronary heart disease accounted for 60.38%, and patients with type-2 diabetes accounted for 37.74%. All of them were higher than those in the middle-aged group. The difference in hypertension was statistically significant （X2 =31.459, P = 0.000）. The proportion of IV-level cardiac fimction in the elder group was far higher than that of the middle-aged group. The difference was statistically significant （X2 = 10.489, P=0.001）. The cases of fully expand of heart and pulmonary hypertension in the elderly group were significantly higher than those in the middle-aged group. The differences were statistically significant （heart expand： X2 = 11.376, P = 0.001, pulmonary hypertension： X2 = 20.362, P = 0.000）. The cases of rupture of mitral valve small chordae tendineae were more than those in the middle-aged group. The difference was statistically significant （X2 = 9.799, P = 0.002）. The cases of the thick chordal rupture were less than those in the middle-aged group. The difference was statistically significance （X2 = 11.118, P= 0.001）. Conclusion：To RMCT patients with chronic diseases such as hypertension, coronary heart disease and diabetes, it is highly recommended that they should have regular echocardiographic examination and a reasonable treatment to reduce the incidence of heart failure.