超声心动图参数预测左心疾病相关性肺动脉高压的血流动力学特征  

Echocardiography predicts the hemodynamics typing of pulmonary hypertension due to left heart disease

作　　者：李俊[1] 赵勤华[2] 宫素岗[2] 王岚[2] 刘锦铭[2] LI Jun;ZHAO Qinhua;GONG Sugang;WANG Lan;LIU Jinming(Department of Intensive Care Unit,Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院重症医学科,上海201318 [2]同济大学附属上海市肺科医院肺循环科

出　　处：《上海医学》2020年第12期729-733,共5页Shanghai Medical Journal

基　　金：重大疾病防治科技行动计划(ZX-01-C2016144),上海市卫生和计划生育委员会青年课题(20174Y0143),国家重点研发计划(2018YFC1313603)。

摘　　要：目的评价简化的超声心动图(echocardiography,Echo)参数无创性评估左心疾病相关性肺动脉高压(PH-LHD)患者的血流动力学特征。方法回顾性分析同济大学附属上海市肺科医院肺循环科2015年8月—2018年7月经右心导管(RHC)确诊的85例PH-LHD患者,根据血流动力学将其分为孤立性毛细血管后肺动脉高压(Ipc-PH)组72例,毛细血管前-后混合性肺动脉高压(Cpc-PH)组13例。收集所有患者的临床资料、Echo参数,以及血流动力学数据。RHC检查与Echo检查间隔1周以内。分析Echo各参数的差异,利用logistic回归分析建立预测PH-LHD患者血流动力学特征的模型。结果Cpc-PH组患者的主肺动脉内径[(32.0±4.2)mm]、肺动脉收缩压[PASP,(75.9±21.0)mmHg(1 mmHg=0.133 kPa)]、右心室游离壁厚度[(7.8±1.4)mm]、收缩期右心房横径[(50.1±8.3)mm]、收缩期右心房纵径[(62.1±12.4)mm]和舒张期右心室横径[RVDd,(39.5±6.7)mm]的数值均显著高于Icp-PH组[(28.1±5.3)mm、(54.0±13.9)mmHg、(6.6±1.4)mm、(44.7±7.7)mm、(55.2±9.8)mm、(34.4±5.9)mm,P值分别<0.01、0.05]。经多因素logistic回归分析显示,PASP和RVDd均为诊断Cpc-PH的独立预测因子,两者联合(PASP≥62.5 mmHg,RVDd≥35.6 mm)诊断Cpc-PH的ROC的AUC为0.874,灵敏度为0.846,特异度为0.778。结论PH-LDH患者可以通过Echo参数的PASP和RVDd联合预测其血流动力学特征。Objective To evaluate the hemodynamic typing of patients with pulmonary hypertension due to left heart disease(PH-LHD)by simplified echocardiography(Echo)parameters.Methods A total of 85 patients with PH-LHD diagnosed by right heart catheter(RHC)from August 2015 to July 2018 in the Pulmonary Circulation Department of Shanghai Pulmonary Hospital were retrospectively analyzed.According to hemodynamic results,72 patients were induded in isolated post-capillary pulmonary hypertension(Ipc-PH)group and 13 patients were induded in combined post-capillary and pre-capillary pulmonary hypertension(Cpc-PH)group.Clinical data,Echo and hemodynamic data were collected.The interval between RHC and Echo was less than one week.The differences of Echo parameters were analyzed,and the model for predicting the hemodynamic typing of PH-LHD was established by logistic regression analysis.Results The main pulmonary artery diameter(MPA),pulmonary artery systolic pressure(PASP),diastolic right ventricular free wall diameter(RVWDd),systolic right atrial diameter(RADs),systolic right atrial longitudinal diameter(RALDs),and diastolic right ventricular diameter(RVDd)in Cpc-PH group were significantly higher than those in Ipc-PH group([32.0±4.2]mm vs.[28.1±5.3]mm,[75.9±21.0]mmHg vs.[54.0±13.9]mmHg[1 mmHg=0.133 kPa],[7.8±1.4]mm vs.[6.6±1.4]mm,[50.1±8.3]mm vs.[44.7±7.7]mm,[62.1±12.4]mm vs.[55.2±9.8]mm,[39.5±6.7]mm vs.[34.4±5.9]mm,P<0.01,0.05).Multivariate logistic regression analysis showed that PASP and RVDd were independent factors in the diagnosis of Cpc-PH,and the combination of the two parameters(PASP≥62.5 mmHg and RVDd≥35.6 mm)in predicting the Cpc-PH had an area under curve(AUC)of 0.874,with the sensitivity and specificity being 0.846 and 0.778,respectively.Conclusion Combination of the PASP and RVDd is helpful to predict the hemodynamic typing of PH-LDH patients.

关 键 词：高血压 肺性 血流动力学 左心疾病 超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R544.1[医药卫生—内科学]