探讨大动脉炎与白塞病所致主动脉瓣反流的临床及超声心动图特征。

收集2002年1月至2016年12月于首都医科大学附属北京安贞医院临床诊断为大动脉炎（TA）及白塞病（BD）、因主动脉瓣反流（AR）行手术治疗的患者的临床资料，其中TA 25例（TA组）、BD 23例（BD组）。比较分析2组患者的临床及超声心动图特征，以及术后并发症发生情况，采用独立样本t检验及χ²检验进行统计学分析。

25例TA患者术前均得到正确诊断。23例BD患者中术前正确诊断16例，7例由临床医师术后诊断。TA组中女性21例（21/25，84%），男性4例；BD组中女性4例，男性19例（19/23，83%），2组性别比较差异有统计学意义（P＜0.01）。BD组术前红细胞沉降率和C反应蛋白高于TA组，2组比较差异均有统计学意义（P均＜0.05）。BD组术前超声心动图显示主动脉瓣形态学表现具有特异性，16例表现为主动脉瓣脱垂伴瓣叶变薄、冗长，部分主动脉瓣呈瘤样改变；6例表现为与瓣叶附着的活动性条索状回声；6例表现为主动脉瓣周囊袋状无回声结构。TA组超声心动图显示主动脉瓣形态学无明显特异性，TA组主动脉根部和升主动脉的内径明显大于BD组（P均＜0.05）。术后随访发现25例TA患者均无并发症发生，10例（43%）BD患者出现术后并发症，包括主动脉机械瓣瓣周漏10例、主动脉机械瓣撕脱5例、冠状动脉吻合口漏1例、主动脉周围假性动脉瘤1例。

伴发AR的BD患者主动脉瓣炎性损害较TA患者更严重，超声心动图对严重AR病因的术前准确评估很重要，术前准确诊断将有助于改变其治疗方式、减少术后并发症。

To investigate the clinical and echocardiographic characteristics of aortic regurgitation caused by Takayasu arteritis (TA) and Behcet's disease (BD).

The clinical data of patients who were clinically diagnosed as having TA and BD and underwent surgical treatment due to aortic regurgitation (AR) at Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2002 to December 2016 were collected, including 25 patients with TA (TA group) and 23 patients with BD (BD group). The clinical and echocardiographic characteristics and postoperative complications of the two groups were compared and analyzed. The independent sample t-test and chi-square test were used for statistical analysis.

All the 25 patients with TA were correctly diagnosed before operation. Among the 23 patients with BD, 16 were correctly diagnosed before operation and 7 were diagnosed by clinicians after operation. In the TA group, there were 21 females (21/25, 84%) and 4 males. In the BD group, there were 4 females and 19 males (19/23, 83%). The difference in gender distribution between the two groups was statistically significant (P＜0.01). The erythrocyte sedimentation rate and C-reactive protein in the BD group were significantly higher than those in the TA group before operation (P＜0.05). In the BD group, preoperative echocardiography showed specific morphological manifestations of aortic valves: aortic valve prolapse with unusual aortic cusp thinning and redundancy in 16 patients, vegetation-mimicking mobile lesions from the aortic valve in 6, and annular echo-free spaces within the annulus in 6. In the TA group, echocardiography showed that there was no obvious specificity in the morphology of aortic valves. The diameter of the aortic root and ascending aorta in the TA group was significantly larger than that in the BD group (P＜0.05). During the follow-up period, 25 patients with TA had no complications, and 10 patients (43%) with BD had postoperative complications, including 10 cases of perivalvular leakage of aortic mechanical valve, 5 cases of aortic mechanical valve avulsion, 1 case of coronary anastomotic leakage, and 1 case of periaortic pseudoaneurysm.

The inflammatory damage of the aortic valve in BD patients with AR is more serious than that in TA patients. Echocardiography is very important for accurate preoperative evaluation of the cause of severe AR. Accurate preoperative diagnosis will help to change the treatment methods and reduce postoperative complications.