组织多普勒对单纯先天性心脏病相关肺动脉高压的再评估  

Evaluation of pulmonary arterial hypertension with simple congenital heart disease using tissue Doppler imaging

作　　者：杜佩[1] 杜国庆[1] 李海茹[1] 陈双[1] 吴言[1] 田家玮[1] 

机构地区：[1]哈尔滨医科大学附属第二医院超声医学科,150086

出　　处：《中华超声影像学杂志》2014年第8期645-650,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81371632）

摘　　要：目的 探讨组织多普勒技术评估常见单纯先天性心脏病患者肺动脉压力、判断肺动脉高压（PAH）及分级的应用价值.方法 经手术或介入证实的单纯先天性心脏病（房间隔缺损、室间隔缺损及动脉导管未闭）患者104例,均行组织多普勒检查和右心导管测压.根据右心导管所测肺动脉平均压（mPAP）分为PAH组60例[mPAP≥25 mmHg（1 mmHg=0.133 kPa）且肺毛细血管楔压（PCWP）≤15mmHg]和非肺动脉高压（non-PAH）组44例（mPAP＜25 mmHg）.根据严重程度PAH组又分为轻度（25mmHg≤mPAP≤35 mmHg）、中度（36 mmHg≤mPAP≤50 mmHg）及重度（mPAP＞50 mmHg）三个亚组.组织多普勒测量三尖瓣环运动速度,获得三尖瓣环收缩期峰值速度（TS＇）、舒张早期峰值速度（TE ＇）、舒张晚期峰值速度（TA＇）以及TE＇/TA＇,并计算Tei指数,以上各参数均与右心导管所测肺动脉压力（sPAP、mPAP、dPAP）行相关性分析.结果 ①PAH组TS＇和TE＇较non-PAH组明显降低（P＜0.05）,Tei指数较non-PAH组明显升高（P＜0.001）,而TA＇和TE＇/TA＇在两组间差异无统计学意义（P＞0.05）;②多因素相关分析：Tei指数与肺动脉压力呈正相关（P＜0.001）,TS＇与肺动脉压力呈负相关（P＜0.05）,而TE＇、TA＇和TE＇/TA＇与肺动脉压力无相关性（P＞0.05）;③ROC曲线分析：Tei指数和TS＇判断PAH的曲线下面积分别为0.893和0.699,Tei指数＞0.49和TS＇＜16 cm/s提示PAH的敏感性分别为86.67％和80.00％,特异性分别为79.55％和45.45％;④中、重度PAH的Tei指数较轻度PAH明显增高（P＜0.05）,重度PAH的TS＇和TE＇较轻、中度PAH减低（P＜0.05）.Tei指数＞0.55提示中-重度PAH的敏感性为95.24％,特异性为72.22％.结论 组织多普勒测得Tei指数和TS ＇在判断PAH及分级方面具有较高的临床应用价值;Tei指数＞0.49可提示PAH,而Tei指数＞0.55提示中重度PAH;TS＇＜16 cm/s提示PAH亦具有一定的参考价值Objective To evaluate the value of tissue Doppler imaging （TDI） in diagnosing pulmonary arterial hypertension（PAH） with common simple congenital heart disease（CHD）.Methods 104 patients of CHD approved by operation or intervention were retrospectively analyzed.Both TDI and right cardiac catheterization were performed in all patients,whose were divided into PAH and non-PAH groups according to mean pulmonary arterial pressure （mPAP） on diagnostic right cardiac catheterization：60 PAH patients[mPAP ≥25 mmHg（1 mmHg =0.133 kPa） and pulmonary arterial capillary wedge pressure ≤15 mmHg],44 non-PAH patients （mPAP ＜25 mmHg）.The PAH group was divided into mild （25 mmHg≤ mPAP≤35 mmHg）,moderate （36 mmHg≤mPAP≤50 mmHg） and severe （mPAP＞50 mmHg） subgroups.The tricuspid annular systolic peak velocity （TS＇）,early diastolic peak velocity （TE＇）,late diastolic peak velocity （TA＇） were measured by TDI and TE＇/TA＇ and Tei index were calculated.The correlation between TDI parameters and the cardiac catheterization findings （sPAP,mPAP and dPAP） were assessed.Results ①TS＇ and TE＇ in PAH group were significantly lower than those in non-PAH（P ＜ 0.05）,but Tei in PAH group were significantly higher than that in non-PAH （P ＜0.001）,however,there were no significant difference in TA＇ and TE＇/TA＇ between two groups （P ＞ 0.05）.②Tei correlated positively with pulmonary arterial pressure （P ＜0.001）,TS＇ was found to be negatively correlated with pulmonary arterial pressure（P ＜0.05）,but no correlation between TE＇,TA＇,TE＇/TA＇ and pulmonary arterial pressure（P ＞0.05）.③ROC analysis showed the area under curves for Tei index and TS＇ diagnosis for PAH was 0.893 and 0.699,respectively.At the cutoff of Tei＞0.49 and TS＇＜16 cm/s for indicating PAH,the sensitivity were 86.67 ％ and 80.00％,respectively and the specificity were 79.55 ％ and 45.45 ％,respectively.④Tei in the moderate and severe PAH were signifi

关 键 词：超声心动描记术 高血压 肺性 心脏缺损 先天性 组织多普勒成像 

分 类 号：R541.4[医药卫生—心血管疾病] R544.1[医药卫生—内科学] R540.45[医药卫生—临床医学]