经胸多普勒超声心动图定量估测肺动脉收缩压的准确性  

Accuracy of transthoracic Doppler echocardiography in the estimation of pulmonary artery systolic pressures

作　　者：孙云娟[1] 曾伟杰[1] 何建国[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院肺血管病诊治中心,100037

出　　处：《中华医学杂志》2011年第28期1945-1948,共4页National Medical Journal of China

基　　金：基金项目：困家科技支撑计划课题（2006BA101A07）

摘　　要：目的 评价经胸多普勒超声心动图（TDE）定量估测肺动脉收缩压（PASP）的准确性.方法 回顾性分析2005年4月至2009年7月102例确诊为特发性肺动脉高压的成人患者的临床资料.患者均在右心导管检查前72 h内完成TDE检查.期间患者病情稳定,治疗方案不变.以右心导管测量的PASP为标准,评价TDE测量PASP的准确性.结果 在102例研究对象中,男38例,女64例；年龄18～59岁,平均（31±11）岁.Pearson相关分析显示TDE与右心导管测量的PASP中度相关（r=0.64,P〈0.01）.Bland-Altman分析显示,TDE测量的PASP比右心导管平均低6.7 mm Hg（95%CI：－47.6～34.3 mm Hg,1 mm Hg=0.133 kPa）.TDE与右心导管测量PASP差值在10 mm g以上者60例（58.8%）,其中TDE低于右心导管测量者44例（43.1%）,高于右心导管测量者16例（15.7%）.尽管TDE低估与高估PASP值的幅度差异无统计学意义[（25±12）比（26±16） mm Hg,P=0.765],但低估PASP的可能性明显大于高估.根据PASP严重程度分级的诊断归类,16例高估患者归类无差错（错误=0）；但在44例低估患者中,9例（20.5%）归类为小错（错误=1）,2例（4.5%）归类为大错（错误=2）.结论 TDE定量估测PASP常不准确,不能替代右心导管检查.TDE更易于低估肺动脉高压患者的PASP,并可导致低估患者诊断归类错误.Objective To investigate the qualitative accuracy of pulmonary artery systolic pressure （PASP） as estimated by transthoracic Doppler echocardiography （TDE）. Methods A retrospective study was conducted on 102 adult patients with idiopathic pulmonary arterial hypertension undergoing Doppler echocardiography within 72 hours prior to right heart catheterization. During this period, all patients were stable without any specific drug therapy. Compared with right heart catheterization, the accuracy of PASP as measured by TDE was evaluated. Results Among them, there were 38 males and 64 females with an average age of （31±11） years old （range： 18-59 years old）. There was a moderate correlation between the measurements of PASP by TDE and right heart catheterization （r=0.64, P〈0.01）. Through the analysis of Bland-Altman, the bias for the TDE estimates of PASP was 6.7 mm Hg with a 95% limit of agreement ranging from -47.6 to 34.3 mm Hg. There were 60 （58.8%） cases with absolute differences over 10 mm Hg between two methods. Overestimation and underestimation of PASP by TDE occurred in 15.7% （16/102） and 43.1% （44/102） respectively. The magnitude of pressure underestimation and overestimation was insignificant [（25±12） vs （26±16） mm Hg, P=0.765]. The probability of underestimate was higher than that of overestimate. As to the corresponding diagnostic categories of severity that each subject would fall into for each technique, the diagnostic categories of 16 overestimated patients were in accordance. Among 44 underestimated patients, 9 （20.5%） had their pressure underestimated within one diagnostic category （minor error） while 2 （4.5%） were within two diagnostic categories （major error）. Conclusion Due to a frequent rate of inaccurate estimation of PASP, TDE can not replace right heart catheterization. TDE tends to underestimate PASP and results in a diagnostic misclassification of degree.

关 键 词：高血压 肺性 超声心动描记术 多普勒 心脏导管插入术 

分 类 号：R540.45[医药卫生—心血管疾病]