慢性高原心脏病患者肺动脉收缩压对心脏结构及功能的影响  

Association between degree of pulmonary artery hypertension and cardiac structural and functional changes in chronic high altitude heart disease patients

作　　者：达娃次仁[1] 格桑罗布[1] 卓玛次仁[1] 李奎[1] 古桑拉姆[1] 张令军[1] 次旦罗布[1] 格桑嘎瓦[1] 达瓦[1] 

机构地区：[1]西藏自治区人民医院心内科,拉萨850000

出　　处：《中华心血管病杂志》2013年第9期761-765,共5页Chinese Journal of Cardiology

基　　金：西藏自治区自然科学基金（2009）

摘　　要：目的 了解慢性高原心脏病（HAHD）不同程度肺动脉高压（PAH）患者心脏结构及功能的变化。方法 对2010年1月至2011年1月我院收治的99例HAHD患者根据超声心动图估测肺动脉收缩压（PASP）水平，将PAH分为轻度：30～49 mm Hg（1 mm Hg=0.133 kPa）；中度：50～69 mm Hg；重度：70 mm Hg以上三组，对各组患者心脏结构、心功能、心律失常情况及全血N末端B型利钠肽原（NT-proBNP）水平等进行比较。另选同期入院无明确器质性疾病者50例作对照组。 结果 右心室前壁厚度在中、重度PAH组较对照组显著增加［（5.10±2.23）、（7.00±2.29）mm 比（3.70±0.92）mm, P〈0.05］，重度PAH组较轻、中度PAH组也显著增加［（7.00±2.29）mm比（4.58±1.80）、（5.10±2.23）mm，P〈0.05］，但轻度PAH组与对照组之间差异无统计学意义；HAHD右心室内径在轻、中、重度PAH组较对照组显著增加［（24.36±4.99）、（27.68±5.45）、（29.72±5.18）mm比（17.64±2.88）mm，P〈0.01］，右心室流出道内径在轻、中、重度PAH组较对照组显著增加［（27.62±5.40）、（30.95±6.18）、（29.91±5.38）mm比（24.67±3.98）mm，P〈0.01］。中、重度PAH组较轻度PAH组也有显著增加（P〈0.01）。心室间隔厚度在轻、中、重度PAH组较对照组显著增加［（8.78±1.45）、（9.77±1.38）、（9.82±1.5 3）mm 比（7.98±1.47）mm ，P〈0.05］。左心房前后径轻、中、重度PAH组较对照组显著增加（P〈0.05），但在各PAH组之间差异无统计学意义。左心室射血分数在HAAD轻、中、重度PAH组较对照组显著下降［（67.26±8.76 ）、（ 60.24±13.78）、（63.95±11.50） mm 比（71.40±7.41）mm，P〈0.05］,中度PAH组较轻度PAH组进一步下降（P〈0.05），但在重度PAH组较中度PAH组反而有所升高［（63.95±11.50）mm比（60.24±13.78 ）mm,P〉0.05］。单因素相关分析显示，lgPASP与左心室射血分数（R=-0.103，PObjective To compare the cardiac structural and functional changes in high altitude heart disease （HAHD） patients with various grade of pulmonary artery hypertension （PAH）. Methods Pulmonary artery systolic pressure （PASP） was evaluated by Doppler echocardiography in 100 patients with HAHD and patients were divided into 3 groups： mild （PASP： 30 -49 mm Hg） , moderate （PASP： 50 -69 mm Hg） and severe （PASP≥70 mm Hg） PAH and 50 patients without organic heart disease served as control group. Data on heart structure and function, heart rhythm and whole blood NT-proBNP were compared among groups. Results Right ventricular free wall was significantly thicker in moderate and severe PAH groups than in the control group [ （5.10 ±2.23）mm, （7. 00 ±2.29 ）mm vs. （3.70 ±0. 92）mm, P 〈 0.05], and in the severe PAH group than in mild and moderate PAH groups [ （7.00 ± 2. 29 ）mm vs. （4. 58 ± 1.80 ） mm, （5. 10 ± 2. 23 ） ram, all P 〈 0. 05 ] and which was similar between the mild PAH group and the control group. Right ventricular inter diameter and right ventrieular outflow tract inter diameter were significantly increased in all HAHD groups compared to the control group （ all P 〈 0. 01 ） , and were also significantly increased in moderate and severe PAH groups than in the mild PAH group （ P 〈 0. 01 ） . Thickness of interventrieular septum was also significantly increased in HAHD patients than control group and in moderate and severe PAH groups than in moderate PAH group. Left atrium anterior-posterior diameter was significantly increased in HAHD patients than in control group and was similar among HAHD patients with various degree of PAH. Left ventricular ejection fraction （LVEF） was remarkably decreased in all HAHD groups than in the control group （ P 〈 0. 05 ） , moreover, LVEF was remarkably decreased in the moderate PAH group than in the mild PAH group（ P 〈 0. 05 ）. EF was similar between severe PAH group and moderate PAH group （ P 〉 0

关 键 词：心脏病 高血压 肺性 心脏损伤 

分 类 号：R541.9[医药卫生—心血管疾病]