晚期扩张型心肌病并肺动脉高压临床、右心导管参数特点及相关危险因素分析  

Clinical characteristics and right heart catheter parameters in end-stage dilated cardiomyopathy patients with pulmonary hypertension

作　　者：袁旭明[1] 谌承志[1] 何昕[1] 刘景艳[1] 刘智勇[1] 唐艳芳[1] 王磊[1] 刘伟[1] 彭一鸣[1] 

机构地区：[1]南华大学附属浏阳医院心内科,湖南浏阳410300

出　　处：《临床荟萃》2015年第6期613-617,共5页Clinical Focus

摘　　要：目的研究晚期扩张型心肌病并肺动脉高压患者临床及右心导管参数的特点。方法晚期扩张型心肌病患者39例,根据床旁右心导管所测平均肺动脉压(mPAP)是否大于等于25mmHg(1mmHg=0.133kPa)分为扩张型心肌病并肺动脉高压组(DCM+PH,n=23)及单纯扩张型心肌病组(DCM,n=16),对比两组临床及右心导管参数的特点。结果与DCM组比较,DCM+PH组患者病程长(6.68±5.57)年vs(3.32±3.37)年(P<0.05),氨基末端脑纳肽(NT-proBNP)水平升高(4 232.89±1 430.56)ng/L vs(1 794.80±1 067.95)ng/L(P<0.05),左心室扩大(72.68±11.52)mm vs(65.94±6.81)mm(P<0.05),mPAP增高(39.81±12.90)mmHg vs(17.19±13.61)mmHg(P<0.05),肺动脉楔压(PCWP)增高(25.00±5.93)mmHg vs(11.25±6.77)mmHg(P<0.05),心输出量(CO)降低(3.46±1.25)L/min vs(4.65±1.28)L/min(P<0.05),肺血管阻力(PVR)增高(32.872±23.069)kPa·s·L-1 vs(17.871±8.908)kPa·s·L-1(P<0.05),多因素回归分析显示,病程和NT-proBNP水平是扩张型心肌病并肺动脉高压的独立危险因素。结论晚期扩张型心肌病并肺动脉高压患者mPAP为轻中度升高,有较长的病程,NT-proBNP、PCWP、PVR均升高,CO降低。病程和NT-proBNP水平是扩张型心肌病并肺动脉高压的独立危险因素。Objective To explore the clinical characteristics and right heart catheter parameters in end-stage dilated cardiomyopathy（DCM）patients with pulmonary hypertension（PH）.Methods A total of 39 patients with end-stage DCM were enrolled in this study.In terms of mean pulmonary artery pressure （mPAP）measured by right heart catheter,the DCM patients were divided into normal pulmonary hypertension group （DCM,mPAP〈25 mmHg,n =1 6）and pulmonary hypertension group（DCM＋PH,mPAP≥25 mmHg,n =23）.Results Compared with the DCM patients,DCM＋PH patients showed significant differences in disease duration （6.68 ±5.57）years vs （3.32 ±3.37） years（P 〈0.05）,circulating NT-proBNP level （4 232.89 ± 1 430.56 ）ng/L vs （1 794.80 ± 1 067.95 ）ng/L（P 〈0.05）,left ventricular size （72.68±1 1.52）mm vs （65.94±6.81）mm（P 〈0.05）,mPAP （25.00±5.93）mmHg vs （1 1.25±6.77）mmHg（P 〈0.05）,PCWP（25.00±5.93）mmHg vs （1 1.25±6.77）mmHg（P 〈0.01）,CO（3.46± 1.25）L/min vs （4.65±1.28）L/min（P 〈0.05 ）,and PVR （32.872 ± 23.069 ）kPa.s.L^-1 vs （1 7.871 ± 8.908） kPa.s.L^-1（P 〈0.05）.Multivariate logistic regression analysis revealed that disease duration and circulating NT-proBNP level were considered as the independent risks of DCM patients with PH.Conclusion The end-stage DCM patients with PH had a longer disease duration,larger left ventricle,higher circulating NT-proBNP level,higher mPAP,higher PCWP,higher PVR and lower CO.Disease duration and circulating NT-proBNP level were considered as the independent risks of DCM patients with PH.

关 键 词：心肌病 扩张型 高血压 肺性 心脏导管插入术 

分 类 号：R542.2[医药卫生—心血管疾病]