肺动脉压对左心室射血分数正常心力衰竭患者预后的预测价值  

Prognostic value of pulmonary artery pressure inh patients with heart failure and normal ejection fraction

作　　者：李兴凤[1] 任玉华[1] 梁江久[2] 

机构地区：[1]山东省聊城市人民医院心内科,252000 [2]山东省千佛山医院心内科,250014

出　　处：《中国心血管杂志》2015年第3期161-165,共5页Chinese Journal of Cardiovascular Medicine

基　　金：山东省自然科学基金项目(ZR2010HM116)~~

摘　　要：目的分析肺动脉压（PAP）在左心室射血分数正常的心力衰竭（HFn EF）患者中的诊断、评估及预后价值。方法入选我院心内科2011年1月至2014年1月临床诊断为HFn EF的210例患者,对其临床资料进行回顾性分析,依照纽约心脏病协会（NYHA）心功能分级分为Ⅱ级（70例）、Ⅲ级（70例）和Ⅳ级（70例）3组,比较3组间PAP和N末端脑钠肽前体（NT-pro BNP）水平等,对PAP特点及住院死亡率、再入院率进行分析。结果 HFn EF患者的左心室射血分数正常（45%-62%）,E/A比值均小于1,NT-pro BNP水平明显升高（973-6 100 ng/L）,随心功能分级增加,超声心动图显示左心房及右心室明显增大,PAP逐渐升高,心功能Ⅳ级组PAP（67±11）mm Hg高于心功能Ⅲ级组[（45±4）mm Hg,P=0.03],均明显高于心功能Ⅱ级组PAP[（25±5）mm Hg,P〈0.01];随PAP升高,重度PAP升高组（〉60 mm Hg）3、6和12个月再入院率均高于中度PAP升高组（40-60 mm Hg,P=0.04、0.03和0.02）,均高于轻度PAP升高组（20-40 mm Hg,均为P〈0.01）;重度PAP组的3、6和12个月死亡率均高于中度和轻度PAP升高组（均为P〈0.05）。结论 PAP可作为HFn EF诊断、评估及预后的有效指标。Objective To analyze the effect of pulmonary artery pressure on diagnosis,evaluation and prognosis of patients with heart failure. Methods The 210 patients with heart failure and normal ejection fraction in the department of cardiology of the hospital from January 2011 to January 2014 were selected and divided into NYHA Ⅱ to Ⅳ group according to NYHA classification,70 patients in each group. The data of the patients were analyzed retrospectively. All patients were conducted PAP and biochemical test and serum NT-pro BNP levels. The pulmonary artery pressure characteristics,hospital mortality and the readmission rate for patients with HFn EF were analyzed. Results LVEF of the patients was（ 45%-62%）. E / A 1 and serum level of NT-pro BNP（ 973-6 100 ng / L） elevated in all patients. With the NYHA class of HFn EF increased, the left atrium, right ventricle and pulmonary artery pressure significantly increased. The PAP [（ 67 ± 11） mm Hg] in NYHA Ⅳ group was significantly higher than in NYHA Ⅲ group [（ 45 ± 4） mm Hg,P = 0. 03] and NYHA Ⅱ group [（ 25 ± 5） mm Hg,P〈0. 01]. With the PAP increased,the hospital mortality and readmission rate increased. The readmission rate of PAP severely elevated group（〉 60 mm Hg） was significantly higher than the PAP moderately elevated group（ 40-60 mm Hg,P = 0. 04,0. 03,0. 02） at 3,6,12 month,and significantly higher than the PAP mildly elevated group（ 20-40 mm Hg,all P〈0. 01） at 3,6,12 month. The hospital mortality of PAP severely elevated group（ 〉60 mm Hg） was higher than the PAP moderately elevated group（ 41-60 mm Hg,P =0. 03,0. 03,0. 02） at 3,6,12 month,and significantly higher than the PAP mildly elevated group（ 20-40 mm Hg,all P〈0. 01） at 3,6,12 month. Conclusions Pulmonary artery pressure can be used as one of effective index to diagnosis,judge the prognosis of patients with heart failure and normal ejection fraction.

关 键 词：肺动脉压 心力衰竭 左心室射血分数正常 预后 

分 类 号：R541.6[医药卫生—心血管疾病]