肺动脉高压患者三尖瓣环收缩期位移/肺动脉收缩压比值与右心导管血流动力学参数的相关性研究  

Relevance of the tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure ratio and hemodynamic parameters in pulmonary arterial hypertension

作　　者：彭锦莉 李文秀[1] 李强强[1] 张陈[1] 吴江[1] 徐茁原 张红胜 耿斌[1] 顾虹[1] PENG Jinli;LI Wenxiu;LI Qiangqiang;ZHANG Chen;WU Jiang;XU Zhuoyuan;ZHANG Hongsheng;GENG Bin;GU Hong(Department of Pediatic Cardiac Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏中心,100029

出　　处：《心肺血管病杂志》2021年第1期37-42,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金资助项目(81570442)。

摘　　要：目的:本研究旨在探讨特发性肺动脉高压(IPAH)及先天性心脏病相关肺动脉高压(CHD-PAH)患者,三尖瓣环收缩期位移(TAPSE)与肺动脉收缩压(PASP)比值与临床指标及右心导管血流动力学参数之间的相关性。方法:回顾性分析2015年9月至2016年11月,北京安贞医院小儿心脏中心收治的IPAH及CHD-PAH患者,所有患者均同步(检查时间相距不超过24 h)行超声心动图和右心导管(RHC)检查评价右心室和肺动脉血流动力学状况,计算TAPSE/PASP比值,根据TAPSE/PASP比值三分位数进行分层[低层组:<0.23 mm/mmHg(1 mmHg=0.133 kPa);中层组:0.23~0.33 mm/mmHg;高层组:>0.33 mm/mmHg]比较,并与临床参数及血流动力学指标进行相关分析。结果:37例PAH患者中IPAH 8例,CHD-PAH 29例,根据TAPSE/PASP比值将患者分层分组,低层组13例,中层组13例,高层组11例,结果显示,与中、高层组相比,低层组患者的各项血流动力学指标更差,右心功能状态明显受损;相关分析结果表明,TAPSE/PASP比值与6分钟步行距离(6MWD)、BNP、混合静脉血氧饱和度(SvO2(%))、肺动脉收缩压(sPAP)、肺动脉舒张压(dPAP)、肺动脉平均压(mPAP)、心输出量(CO)、肺血管阻力(PVR)、肺血管阻力指数(PVRI)及肺体循环阻力比(RP/RS)具有显著相关性(P<0.05),且TAPSE/PASP比值与BNP、sPAP、dPAP、mPAP、PVR、PVRI及RP/RS呈负相关。结论:超声心动图所测的TAPSE/PASP比值与临床参数及RHC血流动力学指标具有显著的相关性,是一有意义的反应IPAH及CHD-PAH患者严重程度及右心功能状态的指标。Objective:To explore the correlation between tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure(TAPSE/PASP)ratio,clinical indicators and hemodynamic parameters in patients with idiopathic pulmonary arterial hypertension(IPAH)and pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH).Methods:Patients with IPAH and CHD-PAH who admitted to pediatric cardiovascular center of Beijing Anzhen hospital between September 2015 and November 2016 were retrospectively analyzed.All patients underwent right ventricle(RV)and pulmonary hemodynamic evaluation by echocardiography and right heart catheterization(RHC)(interval less than 24 h).The TAPSE/PASP ratio was calculated and stratified according to TAPSE/PASP ratio tertiles(low:<0.23 mm/mmHg;middle:0.23 to0.33 mm/mmHg;high:>0.33 mm/mmHg),and the correlation of TAPSE/PASP ratio with clinical parameters and hemodynamic indicators were analyzed.Results:Among 37 PAH patients,8 were IPAH and 29 were CHD-PAH.When stratified by tertile of TAPSE/PASP ratio,13 were low tertile,13 were middle tertile and 11 were high tertile.Patients in the low tertile showed significantly compromised hemodynamic and echocardiographic status compared with patients in the middle and high tertiles.The correlation analysis result showed that TAPSE/PASP ratio was significantly correlated with 6 MWD,BNP,SvO2(%),sPAP,dPAP,mPAP,CO,PVR,PVRI and RP/RS(P<0.05),and the TAPSE/PASP ratio was negatively correlated with BNP,sPAP,dPAP,mPAP,PVR,PVRI,RP/RS.Conclusions:The TAPSE/PASP ratio measured by echocardiography is significantly correlated with the clinical parameters and hemodynamic indexes measured by RHC,and is a meaningful parameter which reflected the severity and right cardiac function of patients with IPAH and CHD-PAH.

关 键 词：超声心动图 肺动脉高压 三尖瓣的收缩期位移/肺动脉收缩压比值 右心导管检查 

分 类 号：R54[医药卫生—心血管疾病]