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  • 學位論文

比較臺灣女性中二尖瓣脫垂病患與正常個體間 各項身體參數之差異性

Comparison of different body habitus parameters between patients with mitral valve prolapse and normal populations in Taiwanese Female

指導教授 : 盧敏吉 林中生
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摘要


研究背景: 二尖瓣脫垂症(mitral valve prolapse) 是盛行率最常見的一種心臟瓣膜異常,而且先前認為其盛行率可以高達全人口之5%-15%。即使採用較嚴謹之診斷標準,於一般人口中二尖瓣脫垂仍然有2.4% 之盛行率。女性罹患率比男性多兩倍,尤其是年輕女性,常有家族史。二尖瓣脫垂症之病患之體重通常偏輕且瘦弱,血壓通常偏低或正常。二尖瓣脫垂症病患發生直背部症候群( straight back syndrome),脊椎側彎( scoliosis )以及漏斗胸( Pectus excavatum )之盛行率較高。但有關東方女性二尖瓣脫垂患者與各種身體參數包括身高,體重,血壓,身體質量指數( body mass index, BMI),胸廓比值,腰圍之相關研究卻並不常見,可資參考之文獻相當稀少;臺灣地區有關諸如此類之研究更是前所未見。本研究之目的即在於探討臺灣地區女性二尖瓣脫垂病患與正常女性個體中各項身體參數及超音波心圖參數之差異性,並且做一比較。 研究方法與材料: 本研究採用病例對照組研究方法(case-control study) 。自民國98年5月1日起至民國 98年12月31,日止,共收集122位健康受試者及二尖瓣脫垂患者。其中五十九例為病例組,六十三例為對照組。 對照組之正常女性定義為聽診及超音波心圖上並無二尖瓣脫垂之表徵者;病例組為聽診及超音波心圖有二尖瓣脫垂表徵,且無其它器質性心臟病者。兩組之間將就下列六項身體參數包括身高( height) ,體重(weight),血壓 (blood pressure),身體質量指數 (body mass index),胸廓比值(thoracic cage index: 定義為胸腔前後徑與側面徑之比值; 胸腔前後徑定義為胸部 X光側面像第八胸椎前緣至胸骨後緣之距離, 側面徑定義為胸部X光正面像橫隔膜高度肋骨內徑之距離), 以及腰圍(waist circumference)做一測量。在此同時,我們亦對研究對象施行完整之超音波心圖,針對各項身體參數及各項超音波心圖參數, 兩組之間做一比較,並分析其差異性。 結果與發現: 二尖瓣脫垂患者有較長之平均身高( P= 0.0146), 較小之胸廓比值( P=0.000112),在心臟超音波參數方面,與正常個體相比, 二尖瓣脫垂患者之平均心室中隔厚度較薄(P= 0.0426),左心房直徑較小( P= 0.0392);與對照組相比,二尖瓣脫垂患者合併直背症候群之風險顯著增加(16.9% vs 3.2%, P=0.014, OR=6.22),但二尖瓣脫垂患者合併脊椎側彎之風險並未顯著增加(6.8% vs 4.8%, P=0.711, OR=1.42) 。年輕女性二尖瓣脫垂患者,發生症狀之機會遠高於健康女性(91.5% vs 49.2%, P=0.00000037, OR=11.15) 。以邏輯斯迴歸模式研究,可篩選出四個自變數可以預測是否會罹患二尖瓣脫垂,分別是「身高」、「胸廓比值」、「心室中隔厚度」及「右心室收縮壓」。在其他自變數不變的前提下,「身高」每增加一公分,預測結果為”病例組”是預測結果為對照組的1.141倍。「胸廓比值」每增加1倍,則預測結果為”病例組”是預測結果為對照組的0.000321倍。「心室中隔厚度」每增加1公分,預測結果為”病例組”是預測結果為對照組的0.018倍。「右心室收縮壓」每增加1毫米汞柱,預測結果為”病例組”是預測結果為對照組的0.909倍。本研究的四個自變數「身高」、「胸廓比值」、「心室中隔厚度」、「右心室收縮壓」)對預測是否罹患二尖瓣脫垂有 67.2.%的正確率, 其中「偽陰率」為35.6%,「偽陽率」為30.2%。 結論: 與正常女性個體相較 ,本研究發現二尖瓣脫垂患者有較長之身高 ( height),以及較小之胸廓比值(thoracic cage index),二尖瓣脫垂患者之平均心室中隔厚度較薄,左心房直徑較小。我們的研究發現二尖瓣脫垂患有較高之機會發生症狀及合併直背症候羣,與脊椎側彎之關聯並不顯著。胸廓比值越高,是二尖瓣脫垂病患之機會就越低。

並列摘要


background: Mitral valve prolapse (MVP)is one of the most prevalent cardiac valvular abnormalities and was previously thought to affect as much as 5-15% of the population. The weight in patient with MVP are often low, and the habitus may be asthenic. Blood pressure is also normal or low ,orthostatic hypotension is often present. However, among different body parameters,the relationships between patients with mitral valve prolapse and normal subjects in Taiwanese women are unknown. We hypothesize that MVP patients in Taiwanese women would have different body habitus and ec- hocardiographic parameters compared with normal female populations. Method and Material: 59 female patients in the MVP group and 63 normal female in the control group will be collected. In MVP group, patients without other organic heart disease but MVP only will be recruited. The definition of normal female is female who lack of audible and echocardiographic findings of MVP. The ages in both group ranged from 20 to 30 years old and pregnant woman was excluded. Echocardiography was performed in both group, different body parameters among MVP patients and normal female will be compared. Body habitus parameters including height, weight, blood pressure, body mass index (BMI), thoracic ca- ge index ( defined as anteroposterior diameter divided by lateral diameter; the anteroposterior diameter is defined as the distance from the anterior border of T8 to the posterior border of sternum on lateral radiograph , the lateral border is defined as the internal rib cage at the level of diaphragm on frontal radiograph), waist circumference and echocardiographic parameters were measured. Results : In terms of age, there is no difference between MVP and control group .In body habitus parameters, compared with control group, MVP patients have a taller height ( P= 0.0146), and smaller thoracic cage index (P=0.000112). There is no difference in other body habitus parameters such as body weight,BMI ,waist circumference and blood pressure. In echocardiographic parameters, compared with control group, MVP patients have a thinner IVS (P=0.0426), smaller left atrial diameter (P= 0.0392); among other echocardiographic parameters, there was no difference Compared with control group, MVP patients have a significantly increasedrisk of comorbidity of straight back syndrome (16.9% vs 3.2%, P=0.014, OR=6.22) and developing symptoms(91.5% vs 49.2%, P=0.00000037). However, they have a non-significant risk of comorbidity of scoliosis (6.8% vs4.8%, P=0.711,OR=1.42).We defined a binary variable whether the subjects are MVP patients or not as a dependent variable and conducted a logistic regression. Four independent variables are significant in the model, including height,thoracic ratio,IVS , and right ventricular systolic pressure.Among them, the thoracic ratio has the strongest relationship with the dependent variable. The odds ratio of being a MVP patient is 0.000321 times when the thoracic ratio doubles. According to the four independent variables, the predictive accuracy is around 67.2% Conclusion: Compared with normal female populations, females with MVP have a taller height, and smaller thoracic cage index . Besides, Echocardiogrphic parameters measurement revealed that MVP patients have a significantly smaller left atrial diameter and thinner interventricular septum. In our study, MVP patients have a significantly increased risk of comobidity with straight back syndrome and developing symptoms compared with control group, but a nonsignificant increased risk of comobidity with scoliosis. The thoracic cage index has the strongest relationship with dependent variable. Clinically, the higher value of the thoracic cage index, the lower risk of young female would be MVP patients. Key words : Mitral valve prolapse, echocardiography, thoracic cage index

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