Martínez-Lavín M, Bobadilla M, Casanova J, Attié F, Martínez M
Arthritis Rheum. 1982 Oct;25(10):1186-93. doi: 10.1002/art.1780251007.
The frequency of hypertrophic osteoarthropathy in cyanotic congenital heart disease has previously been considered to be very low. Only a few isolated reports have described such an association. We studied 32 consecutive patients older than 6 years with various types of cyanotic congenital heart disease and examined each case for hypertrophic osteoarthropathy. We also assessed the role of the altered cardiopulmonary hemodynamics in the development of hypertrophic osteoarthropathy by means of cardiac catheterization. Our results showed that 31% of the patients had hypertrophic osteoarthropathy. When the hemodynamic parameters of the group of patients with hypertrophic osteoarthropathy were compared with those of the remaining patients, we found significant differences in the systemic blood flow (P less than or equal to 0.05), right-to-left shunt (P less than or equal to 0.05), and arterial oxygen unsaturation (P less than or equal to 0.005). Thus, we found a much higher prevalence of hypertrophic osteoarthropathy in patients with cyanotic congenital heart disease than has previously been recognized. The development of hypertrophic osteoarthropathy is related to the degree of bypass of the lung. This is consistent with the concept that hypertrophic osteoarthropathy results from mediators in the systemic venous circulation that escape inactivation in the pulmonary capillary bed.
此前，人们认为紫绀型先天性心脏病患者中肥厚性骨关节病的发生率很低。仅有少数孤立的报告描述过这种关联。我们对32例年龄大于6岁的不同类型紫绀型先天性心脏病患者进行了连续研究，并对每例患者检查是否患有肥厚性骨关节病。我们还通过心导管检查评估了心肺血流动力学改变在肥厚性骨关节病发生过程中的作用。我们的结果显示，31%的患者患有肥厚性骨关节病。当将患有肥厚性骨关节病的患者组的血流动力学参数与其余患者的参数进行比较时，我们发现全身血流量（P≤0.05）、右向左分流（P≤0.05）和动脉血氧不饱和（P≤0.005）存在显著差异。因此，我们发现紫绀型先天性心脏病患者中肥厚性骨关节病的患病率比之前所认识到的要高得多。肥厚性骨关节病的发生与肺分流程度有关。这与肥厚性骨关节病是由体循环静脉循环中在肺毛细血管床未失活的介质所致这一概念相符。
