肺动脉高压患者心室重构的超声心动图指标与肺阻力的相关性研究  

Relationship Between Echocardiographic Parameters of Ventricular Remodeling and Pulmonary Arterial Resistance in Patients of Pulmonary Artery Hypertension

作　　者：徐楠[1] 吴伟春[1] 牛丽莉[1] 万琳媛[1] 张茗卉[1] 黄丽[2] 王浩[1] 何建国[2] XU Nan WU Wei-chun NIU Li-li WAN Lin-yuan ZHANG Ming-hui HUANG Li WANG Hao HE Jian-guo(Department of Echocardiography, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing 100037, China.)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院肺血管病中心,北京市100037

出　　处：《中国循环杂志》2017年第2期161-164,共4页Chinese Circulation Journal

基　　金：国家科技支撑计划:肺循环疾病及其心功能的研究(2011BAI11B15)

摘　　要：目的:应用经胸二维及三维超声心动图技术研究肺动脉高压患者的双心室重构形态特点与肺小动脉阻力的相关性,探讨心室形态指标对肺小动脉阻力升高大于8.5 Wood的预测价值。方法:收集2012-10至2014-01间在我院接受右心导管检查明确诊断为肺动脉高压的患者61例(肺动脉高压组),正常对照组24例。采集完整的经胸超声心动图二维及三维图像,二维测量舒张末左心室离心指数(LVEId)、收缩末期右心室前后径与左心室前后径比值(RVADs/LVADs)、舒张末期右心室左右径与左心室左右径比值(RVTDd/LVTDd)、收缩末期右心室左右径与左心室左右径比值(RVTDs/LVTDs);三维测量右心室舒张末期容积(3D RVEDV)。将右心导管指标肺小动脉阻力与上述超声心动图形态学指标进行相关性分析,选取强相关的超声心动图指标进行受试者工作曲线(ROC)曲线分析,预测肺小动脉阻力>8.5 Wood。结果:肺动脉高压组LVEId、RVADs/LVADs、RVTDd/LVTDd、RVTDs/LVTDs与正常对照组相比均有明显升高(P<0.01);肺动脉高压组3D RVEDV较正常对照组明显升高(P<0.05)。LVEId、RVADs/LVADs与肺小动脉阻力有强相关性(r=0.670、r=0.666,P均<0.01);RVTDd/LVTDd、RVTDs/LVTDs与肺小动脉阻力有弱相关性(r=0.352、r=0.403,P均<0.01);3D RVEDV与肺小动脉阻力有弱相关性(r=0.304,P<0.05)。应用LVEId及RVADs/LVADs预测肺小动脉阻力>8.5 Wood的曲线下面积(AUC=0.876、0.805,P均<0.001)。结论:应用经胸二维及三维超声心动图技术可通过多种简便指标评价肺动脉高压患者的心室重构形态,二维测量LVEId、RVADs/LVADs、RVTDd/LVTDd、RVTDs/LVTDs及三维方法 3D RVEDV均与肺小动脉阻力有正相关性,通过无创超声心动图指标可初步判断肺血管病变程度。Objective： To study the relationship between ventricular remodeling features and pulmonary arterial resistance （PVR） in pulmonary artery hypertension （PAH） patients by 2-D, 3-D transthoracic echocardiography, and to explore the predictive value of ventricular morphological parameter for PVR〉8.5 Wood unit in relevant patients. Methods： Our research included in 2 groups： PAH group,n=61 patients admitted in our hospital from 2012-10 to 2014-01 with right heart catheterization （RHC） conifrmed diagnosis and Control group,n=24 normal subjects. LVEId, the ratios of RVADs/LVADs, RVTDd/LVTDd and RVTDs/LVTDs were measured by 2-D transthoracic echocardiography; 3DRVEDV was measured by 3-D transthoracic echocardiography. Correlation analysis was conducted between echocardiography parameters and RHC measured PVR parameters; the strongly related echocardiography parameters were studied by ROC curve to assess their predictive value of PVR〉8.5 Wood unit.Results： Compared with Control group, PAH group had increased LVEId, RVADs/LVADs, RVTDd/LVTDd and RVTDs/LVTDs,P〈0.01; elevated 3DRVEDV,P〈0.05. LVEId and RVADs/LVADs were strongly related to PAH （r=0.670 and r=0.666, bothP〈0.01）; 3DRVEDV was weakly related to PAH （r=0.304,P〈0.05）. LVEId and RVADs/LVADs for predicting PVR〉8.5 Wood unit were as AUC=0.876 and 0.805, bothP〈0.001. Conclusion： 2-D and 3-D transthoracic echocardiography may evaluate ventricular remodeling by simple and convenient parameters in PAH patients; LVEId, the ratios of RVADs/LVADs, RVTDd/LVTD, RVTDs/LVTD and 3DRVEDV were positively related to PVR, noninvasive echocardiography could preliminarily determine pulmonary vessel lesion levels.

关 键 词：高血压 肺性 超声心动描记术 导管插入术 

分 类 号：R541[医药卫生—心血管疾病]