肺动脉高压对左心功能衰竭患者预后的影响  

The effect of pulmonary hypertension on the prognosis of left heart failure

作　　者：张建起[1] 徐颖 石蕊[1] 梅金平[1] 郭琼[1] 徐文超[1] 杨琴[1] 张娟[1] ZHANG Jian-qi XU Ying SHI Rui MEI Jin-ping GUO Qiong XU Wen chao YANG Qin ZHANG Juan(Institute of Cardiovascular Disease and Heart Center, Logistics University of PAP, Tianjin 300162, China)

机构地区：[1]武警后勤学院附属医院心脏中心,天津300162

出　　处：《武警后勤学院学报（医学版）》2017年第7期577-580,共4页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨肺动脉压力对左心衰竭患者预后的影响。【方法】入选在我院住院的左心衰竭患者139例,心脏多普勒超声检查心脏左室射血分数和左室舒张末期内径,采用三尖瓣最大返流法估测肺动脉收缩压(pulmonary artery systolic pressure,PASP),同时测定血B型氨基端利钠肽原(N-terminal pro-brain natriuretic peptide,NT-pro BNP)水平。依据NYHA分级将患者分为3组Ⅱ级(n=48),Ⅲ级(n=44),Ⅳ级(n=47),同时入选心功能正常患者作为对照组(n=44);再依据PASP将心衰患者分为4组,PASP≤35 mmHg(1 mmHg=0.1333 k Pa)定义为肺动脉压正常组(n=46),35 mmHg<PASP≤45 mmHg为肺高压Ⅰ级组(n=40),45 mmHg<PASP≤60 mmHg为肺高压Ⅱ级组(n=33),肺动脉压>60 mmHg为肺高压Ⅲ级组(n=20)。所有患者随访1年,记录患者1年再入院率和病死率。【结果】心衰患者中肺动脉高压的发病率为66.9%,而严重心衰患者(NYHAⅢ~Ⅳ)肺动脉高压的发病率高达80.2%。PASP与左室射血分数呈明显负相关(r=-0.778,P=0.000),与NT-pro BNP水平呈明显正相关(r=0.819,P=0.000),与左室舒张末期内径呈明显正相关(r=0.541,P=0.000)。所有患者随访平均(11.39±1.83)个月,合并肺动脉高压的左心衰患者再入院率明显升高(15.2%vs 39.8%,P=0.003),病死率明显升高(4.3%Vs 17.2%,P=0.035)。【结论】肺动脉压力对左心功能衰竭患者的预后判断有重要意义。【Objective】To explore the effect of pulmonary artery systolicpressure（PASP） on the prognosis of left heart failure.【Methods】A total of 139 patients with left heart failure were enrolled in our hospital.Left ventricular ejection fraction（LVEF）,left ventricular end-diastolic dimension（LVEDD） and PASP were measured via Doppler echocardiography.The level of N-terminal probrain natriuretic peptide（NT-proBNP） was also determined.According to NYHA classification,all patients were divided into 3 groups：Class Ⅱ（n=48）,Class Ⅲ（n=44）and Class Ⅳ（n=47）.And those with normal cardiac functions were enrolled as controls（n=44）.In addition,according to PASP,patients with heart failure were also divided into 4 groups：PASP≤35 mmHg（n=46）,35 mmHgPASP≤45mmHg（n=40）,45 mmHgPASP≤60 mmHg（n=33） and PASP60 mmHg（n=20）.All patients were followed up for 1 year to record the readmission rate and mortality.【Results】The incidence of pulmonary hypertension was 66.9% in patients with heart failure,while it was up to 80.2% in patients with severe heart failure（NYHA Ⅲ~Ⅳ）.The PASP was in a obvious negative correlation with LVEF（r=-0.778,P=0.000） and in a significant positive correlation with NT-proBNP（r=0.819,P=0.000） and LVEDD（r=0.541,P=0.000）.The average follow-up was（11.39 ＋ 1.83） months.Compared with the patients with normal pulmonary functions,the readmission rate and mortality in the patients with pulmonary hypertension were higher（15.2% vs 39.8%,P=0.003）（4.3% Vs 17.2%,P=0.035）.【Conclusion】PASP is of important significance in the prognosis of left heart failure.

关 键 词：肺高压 肺动脉压 B型氨基端利钠肽原 心力衰竭 

分 类 号：R541[医药卫生—心血管疾病]