多普勒超声心动图估测肺动脉高压患者血流动力学参数的价值  

Assessed value of hemodynamic parameters measured with Doppler echocardiography in patients with pulmonary hypertension

作　　者：郭璐[1] 刘跃建[1] 解郑良[1] 杨阳[1] 周仲伟[1] 刘晓姝[1] 邹俊[1] 曾杰[2] 李春梅[3] 

机构地区：[1]四川省医学科学院.四川省人民医院呼吸内科,成都610072 [2]四川省医学科学院.四川省人民医院心内科,成都610072 [3]四川省医学科学院.四川省人民医院心血管超声室,成都610072

出　　处：《中华肺部疾病杂志（电子版）》2014年第3期14-19,共6页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：四川省卫生厅科研基金资助项目(090442)

摘　　要：目的通过对肺动脉高压(PAH)患者多普勒超声心动图(DE)及右心导管术(RHC)血流动力学参数测值的比较,评价DE估测PAH血流动力学参数的临床价值。方法选择2009年1月至2012年12月四川省医学科学院·四川省人民医院门急诊及住院部通过DE筛查符合PAH诊断的103例患者进行前瞻性研究,同步比较不同病因及不同肺动脉压力分级的患者RHC与DE血流动力学参数,以了解两种方法测值的相关性。结果 DE和RHC两种方法对PAH患者血流动力学测值右心房平均压(mRAP)、平均肺动脉压(mPAP)和肺动脉收缩压(PASP)的总体相关系数分别为0.741,0.698和0.727(P<0.05)。其中,以上三项参数在肺动脉压力水平中度升高的患者中呈高度相关(r=0.848,0.775,0.813,P<0.05),在肺动脉压力水平重度升高的患者中呈中度相关(r=0.698,0.709,0.712,P<0.05),在肺动脉压力水平轻度升高的患者中呈低度相关(r=0.523,0.473,0.480,P<0.05)。DE诊断PAH的假阳性率为14.56%。而DE诊断结缔组织疾病相关PAH的假阳性率为33.33%。不同病因中,除慢性阻塞性肺疾病外,DE和RHC两种方法在同一疾病组内检测到的不同级别肺动脉压力患者的数量并无统计学差异(P>0.05)。结论 DE与RHC血流动力学测值存在显著相关,但在不同病因及不同肺动脉压力分级的患者中有差别。DE在诊断结缔组织疾病相关PAH的假阳性率可能较其他病因高。DE对慢性阻塞性肺疾病相关性PAH患者的肺动脉压力程度的评估价值可能低于其他类型PAH。Objective To evaluate the diagnostic accuracy of doppler echocardiography（DE） to detect homodynamie parameters in patients with pulmonary arterial hypertension （PAH） compared with fight heart catheterization （RHC）. Methods A total of 103 PAH patients diagnosed by DE were enrolled in this prospective study from outpatient department, emergency center and inpatient department in Sichuan academy of medical sciences ＆ Sichuan provincial people＇s hospital from January 2009 to December 2012. RHC and DE were performed simultaneously to assess the hemodynamic parameters in the patients divided into different groups based on etiologic and degree of pressure elevation. The relations between the hemodynamic variables were assessed with the two measurements. Results The summary correlation coefficients of mean fight atrial pressure （mRAP）, mean pulmonary artery pressure （mPAP） and pulmonary artery systolic pressure （PASP） estimated by DE and RHC were 0. 741, 0. 698 and 0. 727 respectively （ P 〈 0. 05 ）. There was a strong correlation in the three hemodynamic parameters between DE and RHC in the patients with moderate degree of pressure elevation （r = 0. 848,0. 775 ,0. 813 , P 〈0.05）. And there was a moderate correlation in the three hemodynamie datas between the two measurements in the patients with servere degree of pressure elevation （ r = 0. 698, 0. 709, 0.712, P 〈 0.05）. However, a weak correlation was detected in the three variables between the noninvasive and invasive technique in the patients with mild degree of pressure elevation （ r = 0. 523, 0. 473, 0.480, P 〈 0.05 ）. The false positive rate of the diagnosis of PAH measured by DE was 14.56%. Yet the false positive rate of the diagnosis of connective tissue disease（CTD） related to PAH relied on DE was 33.33%. In addition to the etiology of chronic obstructive pulmonary disease （COPD）, there was no statistical difference between DE-estimated and RHC- measured numbers of the patients with different level of p

关 键 词：高血压 肺性 超声心动描记术 导管插入术 血流动力学 

分 类 号：R544.11[医药卫生—心血管疾病] R540.145[医药卫生—内科学]