结缔组织病并发肺动脉高压致心功能不全及其治疗  

Cardiac Insufficiency in Connective Tissue Diseases-complicated Pulmonary Arterial Hypertension and Its Treatment

作　　者：罗雯[1] 李沛霖[1] 李扬[1] 李明玮[1] 李泉[1] 张玲[1] 韩凌[1] 

机构地区：[1]首都医科大学附属复兴医院内科,北京100038

出　　处：《中华临床免疫和变态反应杂志》2008年第4期283-287,共5页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的探讨结缔组织病并发肺动脉高压与心功能不全的关系,及各种治疗方案对肺动脉高压与心功能不全的疗效。方法回顾性分析1996年2月～2008年7月在本院住院的14例明确诊断为结缔组织病并发肺动脉高压的患者,比较治疗前后患者的心电图、胸部X线检查、超声心动图及临床表现。结果肺动脉高压患者X线胸片示右下肺动脉增宽7例,检出率50%,且主要为重度肺动脉高压患者;心电图示右室肥厚4例,检出率28.57%,仅见于重度肺动脉高压患者。肺动脉高压与右室内径增大及右下肺动脉增宽有一定的相关性。14例结缔组织病并发肺动脉高压的患者中左心功能不全4例(28.57%),全心功能不全5例(35.71%)。在各种抗风湿及抗心功能不全的治疗方案中以激素的疗效最为显著,治疗前后比较有统计学意义。结论结缔组织病并发肺动脉高压的心功能不全发病率较高,对结缔组织病并发肺动脉高压患者应常规进行超声心动图检查及胸部影像学检查,以在了解肺动脉压的同时了解心功能状况;早期积极治疗可纠正肺动脉高压,并改善心功能。To discuss the relationship between connective tissue disease （CTD） associated pulmonary arterial hypertension （PAH） and cardiac insufficiency, as well as the effects among the various therapeutic prescriptions against PAH and cardiac insufficiency. Methods Fourteen patients （mean＋SD age, 52±18） diagnosed as having CTD associated PAH （CTDaPAH） were retrospectively analyzed in our Hospital between February 1996 and July 2008. ECG, X-ray, UCG of thoracic part and clinical manifestation before and after treatment for each patient were analyzed and compared. Results Among fourteen patients, the incidence of low right pulmonary artery widening was 50% for patients suffering from moderate or severe PAH, and right ventricular hypertrophy discovered in ECG only occurred in 28.57% of severe PAH patients. Some correlation could be found both between PAH ＆ widening of inner diameter of right ventricle and between PAH ＆ low right pulmonary artery. 4 patients （28.57% 4/14） developed acute left cardiac insufficiency and 5 patients （35.71%, 5/14） developed total cardiac insufficiency. The therapeutic effect of corticosteroid therapy was proven to be the most significant and had statistical significance among the various therapy prescriptions against rheumatism and cardiac insufficiency. Conclusions Our research disclosed the high frequency of cardiac insufficiency in CTDaPAH patients. Routine ECG, Chest X-ray and UCG test for cardiac insufficiency should be applied to CTDaPAH patients in order to monitor simultaneously the pulmonary artery pressure and the status of cardiac functioning. Active treatment was proven to be effective in treating PAH and cardiac insufficiency at early phase.

关 键 词：结缔组织病 肺动脉高压 心功能不全 

分 类 号：R593.2[医药卫生—内科学]