胸廓畸形相关肺动脉高压的临床与血流动力学特点分析  

Clinical and hemodynamic characteristics of pulmonary hypertension associated with thoracic deformity

作　　者：杨飞 王岚[2] 宫素岗[2] 罗祠君[2] 邱宏玲 姜蓉[2] 何晶[2] 刘锦铭[2] 赵勤华[2] YANG Fei;WANG Lan;GONG Sugang;LUO Cijun;QIU Hongling;JIANG Rong;HE Jing;LIU Jinming;ZHAO Qinhua(Department of Geriatric Diseases,Shenyang Tenth People's Hospital(Shenyang Chest Hospital),Shenyang 110000,Liaoning,China)

机构地区：[1]沈阳市第十人民医院(沈阳市胸科医院)干诊老年病科,辽宁沈阳110000 [2]同济大学附属上海市肺科医院肺循环科

出　　处：《上海医学》2019年第8期449-453,共5页Shanghai Medical Journal

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(2018YFC1313603);上海市卫生和计划生育委员会科研课题(20174Y0143)

摘　　要：目的通过比较胸廓畸形相关肺动脉高压(PH)患者与慢性阻塞性肺疾病(COPD)相关PH患者的差异,明确胸廓畸形相关PH的临床特点。方法回顾性分析2010年11月-2018年6月在同济大学附属上海市肺科医院肺循环科住院的胸廓畸形相关PH患者18例,随机抽取同期住院的COPD相关PH患者24例,所有患者均经右心导管检查确诊。比较两组患者一般资料、血生物化学、肺功能、超声心动图、心肺运动试验和血流动力学参数的差异。结果胸廓畸形相关PH组脑钠肽(BNP)、动脉血二氧化碳分压(paCO2)分别为570.5(114.5,1116.0)ng/L和(60.04±8.75)mmHg(1 mmHg=0.133 kPa),显著高于COPD相关PH组的163.3(52.7,333.0)ng/L和(43.72±14.00)mmHg(P值分别<0.05、0.01)。胸廓畸形相关PH组动脉血氧分压(paO2)为(53.65±12.41)mmHg,显著低于COPD相关PH组的(62.75±13.12)mmHg(P<0.05)。胸廓畸形相关PH组存在混合性通气功能障碍,限制性通气功能异常更明显,肺总量(TLC)占预测值百分比为(67.99±26.63)%,显著低于COPD相关PH组的(104.24±23.61)%(P<0.05)。胸廓畸形相关PH组的肺血管病变和右心室受累较轻,肺动脉收缩压(PASP)和右心室横径分别为(62.76±21.69)mmHg和(38.57±4.86)mm,显著小于COPD相关PH组的(75.83±18.92)mmHg和(48.12±13.82)mm(P值均<0.05);血流动力学参数提示胸廓畸形相关PH组患者的肺血管阻力(PVR)为(5.34±2.41)Wood U,显著低于COPD相关PH组患者的(8.16±3.69)Wood U(P<0.05)。结论胸廓畸形相关PH患者较COPD相关PH患者的右心结构和肺血管病变更轻,但存在更为严重的CO2潴留和限制性通气功能障碍。Objective To compare the clinical features between patients with pulmonary hypertension(PH) associated with thoracic deformity and those with chronic obstructive pulmonary disease(COPD). Methods Eighteen patients with PH associated with thoracic deformity who were treated from November 2010 to June 2018 were retrospectively analyzed. Twenty-four contemporaneous patients with COPD-related PH were randomly selected as controls. All patients were diagnosed by right heart catheterization. The general information, blood biochemistry, pulmonary function, echocardiography, cardiopulmonary exercise test and hemodynamic parameters were compared between the two groups. Results The brain natriuretic peptide(BNP) and arterial carbon dioxide pressure(paCO2) in the thoracic deformity-related PH group were significantly higher than those in the COPD-related PH group(570.5[114.5,1 116.0] ng/L vs. 163.3[52.7,333.0] ng/L, P<0.05;[60.04±8.75] mmHg[1 mmHg=0.133 kPa] vs. [43.72±14.00] mmHg, P<0.05、0.01). The arterial blood oxygen partial pressure(paO2) in the thoracic deformity-related PH group was significantly lower than that in the COPD-related PH group([53.65±12.41] mmHg vs. [62.75±13.12] mmHg, P<0.05). There was mixed ventilatory dysfunction and obviously restricted ventilatory dysfunction in the thoracic deformity-related PH group. Compared with those in the COPD-related PH group, the ratio between total lung capacity(TLC) and predicted value, the pulmonary artery systolic pressure(PASP) the right ventricle transverse diameter, and the pulmonary vascular resistance(PVR) were significantly decreased in the thoracic deformity-related PH group([67.99±26.63]% vs. [104.24±23.61]%,(62.76±21.69) mmHg vs.(75.83±18.92) mmHg, [38.57±4.86] mm vs. [48.12±13.82] mm, [5.34±2.41] Wood U vs. [8.16±3.69] Wood U, all P<0.05). Conclusion Patients with PH associated with thoracic deformity have better right heart structure and slighter pulmonary vascular disease than those with COPD-related PH, but the former have more severe CO2 ret

关 键 词：肺疾病 慢性阻塞性 高血压 肺性 血流动力学 胸廓畸形 肺功能 

分 类 号：R[医药卫生]