临界肺循环高压患者的心脏超声评价  

Echocardiographic evaluation of the patients with borderline pulmonary hypertension

作　　者：靳文英[1] 于超[1] 史歆然 陈红[1] 朱天刚[1] Jin Wenying;Yu Chao;Shi Xinran;Chen Hong;Zhu Tiangang(Department of Cardiology,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心脏中心,急性心肌梗死早期预警和干预北京市重点实验室,100044

出　　处：《中华超声影像学杂志》2019年第12期1013-1018,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金面上项目(81670090)。

摘　　要：目的探讨临界肺高压患者的心脏结构和功能变化。方法回顾性分析2018年2-10月北京大学人民医院617例门诊患者的超声心动图数据,根据估测的平均肺动脉压(mPAP)分为正常组(mPAP<19 mmHg)、临界组(19 mmHg≤mPAP<25 mmHg)和升高组(mPAP≥25 mmHg),分析比较各组心脏结构和功能变化。结果①与正常组相比,临界组和升高组患者的年龄较大[(39.2±10.1)岁对(46.5±13.5)岁对(51.8±14.2)岁,均P<0.001],男性比例偏低(69.9%对58.9%对54.4%,均P<0.01),吸烟饮酒和心血管合并疾病的发生率明显升高。②与正常组相比,临界组左房[(30.2±8.2)ml/m2对(34.5±9.7)ml/m2,P<0.001]、左室[(57.4±11.6)ml/m2对(60.6±12.5)ml/m2,P<0.01]和右房[(19.5±5.9)ml/m2对(22.6±7.0)ml/m2,P<0.001]扩大。左室整体长轴应变增加[(-20.1±2.5)%对(-21.1±3.1)%,P<0.001],但右室游离壁中间段的长轴应变降低[(-31.4±6.6)%对(-27.2±8.8)%,P<0.001]。③年龄、性别、右房容积、右室面积、右室三尖瓣环侧壁收缩期最大速度、左室整体长轴应变、右室游离壁中间段应变、二尖瓣E/e′是mPAP升高的独立危险因素。结论肺动脉压临界升高的患者存在房室大小和功能的早期改变,超声心动图对于肺动脉压升高的早期诊断和随访监测至关重要。Objective To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension.Methods Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People′s Hospital were retrospectively analyzed.According to the estimated mean pulmonary artery pressure(mPAP),the patients were divided into normal group(mPAP<19 mmHg),borderline group(19 mmHg≤mPAP<25 mmHg)and elevated group(mPAP≥25 mmHg).Results①Compared with normal group,the patients were older in borderline group and elevated group[(39.2±10.1)years old vs(46.5±13.5)years old vs(51.8±14.2)years old,all P<0.001]and the proportions of male were relatively lower(69.9%vs 58.9%vs 54.4%,all P<0.01).The incidences of smoking,drinking and cardiovascular complications increased significantly.②Compared with normal group,the left atrium[(30.2±8.2)ml/m2 vs(34.5±9.7)ml/m2,P<0.001],left ventricle[(57.4±11.6)ml/m2 vs(60.6±12.5)ml/m2,P<0.01]and right atrium[(19.5±5.9)ml/m2 vs(22.6±7.0)ml/m2,P<0.001]were enlarged in borderline group.Left ventricular global long-axis strain(GLSLV)increased[(-20.1±2.5)%vs(-21.1±3.1)%,P<0.001],but the long-axis strain in the middle segment of right ventricular free wall(GLSRVFWmid)decreased[(-31.4±6.6)%对(-27.2±8.8)%,P<0.001]in borderline group.Meanwhile,left ventricular diastolic function was impaired.③Age,sex,right atrial volume,right ventricular area,RV-S′,GLSLV,GLSRVFWmid and mitral valve E/e′were independent risk factors for mPAP elevation.Conclusions Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension.Echocardiography is critical for the early diagnosis and follow-up monitoring of pulmonary hypertension.

关 键 词：超声心动描记术 肺高斥 平均肺动脉压 

分 类 号：R544[医药卫生—心血管疾病]