吸入伊洛前列素对肺动脉高压患者右心室功能改善的即刻效应:心脏MRI初步研究  

Acute Response of Right Ventricular Function to Iloprost Inhalations in Patients with Pulmonary Arterial Hypertension: Preliminary Evaluation with Cardiac Magnetic Resonance Imaging

作　　者：陆青青[1] 李东[1] 杨振文[2] 韩艳[1] 崔倩[1] 张璋[1] 于铁链[1] 

机构地区：[1]天津医科大学总医院放射科,天津300052 [2]天津医科大学总医院心内科,天津300052

出　　处：《中国肺癌杂志》2015年第3期167-171,共5页Chinese Journal of Lung Cancer

基　　金：国家临床重点专科建设项目;国家自然科学基金(No.81301217);天津市应用基础与前沿技术研究计划重点项目(No.14JCZDJC57000)资助~~

摘　　要：背景与目的肺动脉高压(pulmonary arterial hypertension,PAH)是以肺循环压力异常增高为特征的进展性疾病,可引起右心室(right ventricle,RV)功能进行性衰竭,最终导致死亡。因此RV功能的评估在PAH的诊断、随访中起着重要作用。心脏磁共振成像(cardiac magnetic resonance imaging,CMRI)成为无创评价心室功能的参照标准,尤其是RV功能。本研究通过CMRI评估吸入伊洛前列素对PAH患者RV功能影响的即刻效应。方法 2012年3月-2014年3月PAH患者48例,吸入单剂量20μg的伊洛前列素溶液前、后立即进行CMRI检查,测量RV的舒张末期容积(end-diastolic volume,EDV)、收缩末期容积(end-systolic volume,ESV)、每搏输出量(stroke volume,SV)、射血分数(ejection fraction,EF)、心输出量(cardiac output,CO)、舒张末期面积(end-diastolic area,EDA)及收缩末期面积(end-systolic area,ESA)。RV面积变化百分比(percentage of RV area change,%RVAC)由公式[%RVAC=(EDA-ESA)/EDA×100%]计算获得。采用Wilcoxon符号秩和检验或配对t检验分析吸入伊洛前列素前、后RV功能参数变化。P<0.05为差异有统计学意义。结果吸入伊洛前列素后,患者的RV功能改善,RV EDV、RV ESV显著下降(P=0.007,P<0.001),RV SV、RV EF及%RVAC增加(P=0.014,P=0.009,P=0.006),RV CO无变化(P=0.851)。结论吸入伊洛前列素能立即明显改善PAH患者的RV功能,CMRI能准确、无创地评估该即刻效应。Background and objective Pulmonary arterial hypertension（PAH） is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation. Without treatment, PAH progresses rapidly to right ventricular（RV） failure and even death. Cardiac magnetic resonance imaging（CMRI） has been an accurate and reproducible tool to assessment of RV morphology and function, which are important factors in the prognosis of patients with PAH. The aim of this study is to investigate acute RV response to inhalation of aerosolized iloprost in patients with PAH using CMRI. Method From March 2012 to March 2014, 48 patients with PAH underwent CMRI before and immediately after inhalation of iloprost with a single dose of 20 μg over 15 min-20 min. RV function parameters derived from CMRI images were analyzed before and after iloprost inhalation, including end-diastolic volume（EDV）, end-diastolic area（EDA）, end-systolic volume（ESV）, endsystolic area（ESA）, stroke volume（SV）, ejection fraction（EF） and cardiac output（CO）. Percentage of RV area change was also calculated [%RVAC=（EDA-ESA）/EDA×100%]. Wilcoxon＇s Sign Rank Test or Paired Samples t-Test was used to compare the differences of RV function parameters before and after inhalation. Results After iloprost inhalation, all patients showed significant decrease in RV EDV and RV ESV（P=0.007, P0.001 respectively）. Whereas, there were significant increase in RV SV（P=0.014）, RV EF（P=0.009） and %RVAC（P=0.006）. RV CO had no significant difference before and after inhalation（P=0.851）. Conclusions Inhalation of iloprost can immediately improve RV function in patients with PAH, and noninvasive evaluation of the acute response with CMRI is feasibility.

关 键 词：磁共振成像 伊洛前列素 高血压 肺性 心室功能 右 

分 类 号：R544.1[医药卫生—心血管疾病] R445.2[医药卫生—内科学]