刘博，马爱群

21例乳头肌肥厚型心肌病的临床特点分析

刘博，马爱群

目的：探讨乳头肌肥厚型心肌病的临床特点及心脏磁共振诊断特征分析。

方法：搜集2013-01至2015-12期间在陕西省人民医院确诊的21例乳头肌肥厚型心肌病患者（乳头肌肥厚型心肌病组）的临床资料，其中男性18例，女性3例，进一步行心脏磁共振检查。并与同期无心血管疾病的50例受试者（对照组）行对比分析。

结果：乳头肌肥厚型心肌病的临床症状主要有胸闷、气短、胸痛，伴有二尖瓣听诊区收缩期杂音；心电图检查可正常或者T波倒置；心脏磁共振检查特征是1/2的乳头肌直径超过1.1 cm。两组的甘油三酯、左心房前后径、室间隔厚度、E峰与A峰比值（E/A）、E峰减速时间（EDT）存在差异，有统计学意义（P＜0.05）。

结论：乳头肌肥厚型心肌病临床表现缺乏特异性，发病率及临床意义仍有待确定。

心肌病，肥厚型；磁共振成像；乳头肌肥厚

Abstract

Objective: To explore the clinical and magnetic resonance imaging （MRI） features of papillary musclehypertrophic cardiomyopathy.

Methods: Our research contained 2 groups: Papillary muscle hypertrophic cardiomyopathy group， n=21 patients treated in our hospital from 2013-01 to 2015-12 including 18 male and 3 female； Control group， n=50 subjects without cardiovascular disease those were confirmed by our hospital at the same period of time. Clinical and MRI examinations were conducted in all patients， the findings were compared between 2 groups.

Results: Compared with control subjects， papillary musclehypertrophic cardiomyopathy patients had the main symptoms of shortness of breath， chest tightness and pain； associated with systolic murmur； ECG could be normal or with T wave inversion； cardiac MRI showed that 1/2 papillary muscle diameter＞1.1cm. Blood levels of triglyceride， left atrial diameter， inter-ventricular septum thickness， the values of E/ A and EDT were statistically different between 2 groups， all P＜0.05.

Conclusion: Clinical features of papillary muscle hypertrophic cardiomyopathy were lack of specificity， the morbidity and clinical significance should be further investigated.

2014版欧洲心脏病学会（ESC）肥厚型心肌病的诊治指南认为当出现左心室壁增厚且不能单独由心脏负荷增加来解释时，即可认为是肥厚型心肌病。乳头肌作为左心室的解剖结构，在肥厚型心肌病中尚缺乏系统的观察。乳头肌肥厚型心肌病作为肥厚型心肌病的一种亚型，既往以个案方式报道，国内尚少见相关研究报道。随着心脏磁共振（MR）技术的广泛应用，越来越多的乳头肌肥厚型心肌病被确诊。本研究针对乳头肌肥厚型心肌病进行相关研究，探讨乳头肌肥厚型心肌病的临床特点及MR诊断特征。……