Lewis R P, Wooley C F, Kolibash A J, Boudoulas H
Trans Am Clin Climatol Assoc. 1987;98:222-36.
In spite of two decades of research, the precise relationship of anatomic mitral valve prolapse (floppy valve) to the neuroendocrine disorder (MVP syndrome) remains unclear. In all likelihood they are two separate genetic disorders which travel together in some fashion. Mitral valve prolapse is a common disorder but progressive mitral regurgitation usually occurs late in life and in only a few patients. Other complications such as bacterial endocarditis, stroke, and sudden death are far less common but can occur at younger ages. The neuroendocrine syndrome in civilian life is mainly seen in young females (interestingly the peak incidence years correspond to peak female sex hormone output) but can be seen in males when subjected to unusual stress such as military service. More recent echocardiographic studies have questioned whether all prolapsing valves are truly abnormal. It has been shown that echographic prolapse can be produced in normal subjects by reducing venous return and impaired venous return may be present in some patients with the MVP syndrome. However, clicks and murmurs are apparently not heard when normal valves prolapse. It is our opinion that the presence of a click or typical murmur requires some anatomic abnormality of the mitral valve. One wonders if minimal valve abnormality (noted and dismissed by Davies) is the valve abnormality present in many young females with MVP syndrome, and that it may remain a mild abnormality throughout life. Recent psychiatric studies suggest that MVP is present in 30% of patients with Panic Disorder. It is not clear that this psychiatric syndrome is the same thing as the MVP syndrome. In Devereux's study, anxiety proneness was no different in the MVP cohort than in relatives without MVP. It is possible that diagnostic mixing of two similar but separate disorders has occurred, as has been the case since World War I. Perhaps the most important question is whether young patients with MVP syndrome and no echocardiographic criteria for "floppiness" will develop progressive mitral regurgitation or other complications in later life. In other words, how often is MVP syndrome in a young individual without echocardiographic evidence of a floppy valve a precourser to eventual progressive mitral regurgitation? Are there two different populations? Because of the long course of the disorder, several more years of observation (and, it is hoped, prospective longitudinal study) will be required to answer this question.
尽管经过了二十年的研究，但解剖性二尖瓣脱垂（瓣膜松弛）与神经内分泌紊乱（二尖瓣脱垂综合征）之间的确切关系仍不明确。它们很可能是两种以某种方式共同出现的独立遗传疾病。二尖瓣脱垂是一种常见疾病，但进行性二尖瓣反流通常在生命后期才会出现，且仅在少数患者中发生。其他并发症，如细菌性心内膜炎、中风和猝死则更为少见，但可能在较年轻的时候出现。平民生活中的神经内分泌综合征主要见于年轻女性（有趣的是，发病高峰年龄与女性性激素分泌高峰相对应），但在男性经历如服兵役等异常压力时也可能出现。最近的超声心动图研究对是否所有脱垂的瓣膜都真正异常提出了质疑。研究表明，通过减少静脉回流可使正常受试者出现超声心动图上的脱垂，而二尖瓣脱垂综合征的一些患者可能存在静脉回流受损的情况。然而，正常瓣膜脱垂时显然听不到喀喇音和杂音。我们认为，喀喇音或典型杂音的出现需要二尖瓣存在一些解剖学异常。有人不禁要问，轻微的瓣膜异常（戴维斯曾提及并忽略）是否就是许多患有二尖瓣脱垂综合征的年轻女性所存在的瓣膜异常，并且这种异常可能终生保持轻微。最近的精神病学研究表明，恐慌症患者中有30%存在二尖瓣脱垂。目前尚不清楚这种精神综合征是否与二尖瓣脱垂综合征是同一回事。在德弗罗的研究中，二尖瓣脱垂队列中的焦虑倾向与没有二尖瓣脱垂的亲属并无差异。有可能发生了两种相似但不同的疾病的诊断混淆，自第一次世界大战以来一直如此。也许最重要的问题是，没有超声心动图标准证明瓣膜“松弛”的年轻二尖瓣脱垂综合征患者在晚年是否会发展为进行性二尖瓣反流或其他并发症。换句话说，没有超声心动图证据显示瓣膜松弛的年轻个体中，二尖瓣脱垂综合征最终发展为进行性二尖瓣反流的频率有多高？是否存在两种不同的人群？由于该疾病病程较长，还需要数年的观察（并且希望能进行前瞻性纵向研究）才能回答这个问题。
