心脏磁共振成像对慢性阻塞性肺疾病合并肺动脉高压患者肺动脉血流动力学及右心功能的临床评价  

Assessment of the hemodynamics of pulmonary artery and right ventricular function in chronic obstructive pulmonary disease with pulmonary hypertension using cardiac magnetic resonance imaging

作　　者：范玉春[1] 郭晓桐[1] 孙潇[2] 曹霞 何进喜[3] 朱力[2] 陈娟[1] Fan Yuchun;Guo Xiaotong;Sun Xiao;Cao Xia;He Jinxi;Zhu Li;Chen Juan(Department of Respiratory and Critical Care Discipline,Ningxia Medical University General Hospital,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Radiology,Ningxia Medical University General Hospital,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of General Thoracic Surgery,Ningxia Medical University General Hospital,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学总医院呼吸与危重症医学科,银川750004 [2]宁夏医科大学总医院放射科,银川750004 [3]宁夏医科大学总医院胸外科,银川750004

出　　处：《中华危重病急救医学》2019年第8期972-977,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81360004,81760004);宁夏回族自治区科技支撑计划项目(2015-26).

摘　　要：目的探讨心脏磁共振成像(CMRI)对慢性阻塞性肺疾病(COPD)是否合并肺动脉高压(PAH)患者肺动脉血流动力学及右室功能的评价作用;以及COPD合并PAH患者CMRI测量参数与肺功能参数、血气分析指标及6min步行试验(6MWT)指标的相关关系。方法对2013年10月至2016年10月就诊于宁夏医科大学总医院呼吸与危重症医学科确诊为COPD的37例患者,行经胸超声心动图(TTE)测量肺动脉收缩压(PASP),根据是否存在PAH〔PASP>40mmHg(1mmHg=0.133kPa)认为存在PAH〕将患者分为COPD组和COPD+PAH组。所有患者在1周内均完成肺功能检查〔1秒用力呼气容积与用力肺活量比值(FEV1/FVC)、FEV1预计值(FEV1pred)〕、血气分析〔动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)〕、CMRI检查〔肺动脉干相对扩张度(mPAD)、平均肺动脉压(mPAP)、左室射血分数(LVEF)、右室射血分数(RVEF)、右心室舒张期末心肌质量(RVMED)、右心室收缩期末心肌质量(RVMES)〕及6MWT〔6min步行距离(6MWD)〕。对所获得的临床参数进行组间比较并进行相关性分析。结果入选37例COPD患者中合并PAH16例。两组患者FEV1/FVC、FEV1pred、PaO2、PaCO2等基线指标差异均无统计学意义。COPD组有2例TTE估测PASP为正常参考值(PASP<40mmHg)的患者,CMRI直接获得mPAP高于正常界限(>25mmHg)。与COPD组比较,COPD+PAH组mPAD、RVEF、6MWD明显下降〔mPAD:(25.64±5.01)%比(44.00±22.52)%,RVEF:0.525±0.054比0.592±0.071,6MWD(m):319.3±116.5比408.2±38.0,均P<0.01〕,mPAP、RVMED、RVMES明显升高〔mPAP(mmHg):28.89±3.16比20.18±2.43,RVMED(g):57.19±15.46比40.71±15.44,RVMES(g):45.99±11.16比33.71±13.39,均P<0.01〕,而LVEF差异无统计学意义(0.663±0.082比0.699±0.075,P>0.05)。相关性分析显示,mPAD与FEV1/FVC、FEV1pred呈正相关(r1=0.538、P1=0.021,r2=0.448、P2=0.049);RVMED与PaO2呈负相关(r=-0.581,P=0.015),与PaCO2呈正相关(r=0.592,P=0.014);6MWD与RVEF呈正相关(r=0.485,P=0.041),与LVEF无相关性(r=0.2Objective To investigate the role of cardiac magnetic resonance imaging(CMRI)in evaluating pulmonary hemodynamics and right ventricular function in patients with chronic obstructive pulmonary disease(COPD)and pulmonary hypertension(PAH);and the relationship between CMRI parameters and pulmonary function parameters,blood gas analysis parameters and 6-minute walk test(6MWT)parameters in patients with COPD complicated with PAH.Methods Thirty-seven patients were diagnosed with COPD in the department of respiratory and critical care discipline of Ningxia Medical University General Hospital from October 2013 to October 2016,who underwent transthoracic echocardiography(TTE)to measure pulmonary arterial systolic pressure(PASP),and were divided into COPD group and COPD+PAH group according to whether there was PAH[PASP>40 mmHg(1 mmHg=0.133 kPa)was defined as PAH].All patients completed pulmonary function tests[1 second forced expiratory volume to forced vital capacity ratio(FEV1/FVC),FEV1 predicted value(FEV1pred)],blood gas analysis[arterial blood oxygen partial pressure(PaO2),arterial blood carbon dioxide partial pressure(PaCO2)],CMRI examination[relative dilatation of the main pulmonary artery(mPAD),mean pulmonary artery pressure(mPAP),left ventricular ejection fraction(LVEF),right ventricular ejection fraction(RVEF),right ventricular end-diastolic myocardial mass(RVMED),right ventricular end-systolic myocardial mass(RVMES)],and 6MWD[6-minute walk distance(6MWD)]within 1 week.The obtained clinical parameters had been compared between the groups,and correlation was analyzed.Results Among the 37 patients with COPD,16 patients were complicated with PAH.There were no significant differences in FEV1/FVC,FEV1pred,PaO2,PaCO2 and other baseline indicators between the two groups.In the COPD group,TTE obtained PASP of 2 patients were normal(PSAP<40 mmHg),while CMRI measured mPAP were higher than the normal limit(>25 mmHg).Compared with the COPD group,mPAD,RVEF and 6MWD were significantly decreased in the COPD+PAH group[mPAD:(25.6

关 键 词：慢性阻塞性肺疾病 肺动脉高压 心脏磁共振成像 肺动脉血流动力学 右心功能 

分 类 号：R563.9[医药卫生—呼吸系统] R544.1[医药卫生—内科学] R445.2[医药卫生—临床医学]