左心疾病相关性肺动脉高压的临床特点分析  

Clinical characteristics of pulmonary hypertension due to left heart disease

作　　者：王璐瑶 闫旭龙[2] 杨晓敏[2] 岳建伟 王妍锦 WANG Luyao;YAN Xulong;YANG Xiaomin;YUE Jianwei;WANG Yanjin(Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou,Inner Mongolia,014000,China;Department of Cardiology,Second Affiliated Hospital of Baotou Medical College)

机构地区：[1]内蒙古科技大学包头医学院,内蒙古包头014000 [2]内蒙古科技大学包头医学院第二附属医院心内科

出　　处：《临床心血管病杂志》2021年第5期462-467,共6页Journal of Clinical Cardiology

摘　　要：目的:研究左心疾病相关性肺动脉高压(PH-LHD)的危险因素及不同病变严重程度的临床特点,为疾病的诊治及预后判断提供参考。方法:采用回顾性病例对照研究方法,将包头医学院第一附属医院2018年5月—2020年5月于心内科住院的PH-LHD患者134例作为病例组,有左心疾病但未合并肺动脉高压患者180例作为对照组。通过分析寻找PH-LHD形成的危险因素及不同病变严重程度患者的临床特点。结果:共收集病例314例,PH-LHD患者134(42.7%)例,其中男68例(50.7%),有吸烟史34例(25.4%),有糖尿病史31例(23.1%),有心房颤动(房颤)史50例(37.3%),有高血压史83例(62.0%),心功能NYHA分级Ⅲ、Ⅳ级82例(61.2%)。二元Logistic回归分析发现:年龄(OR=1.073,95%CI:1.038~1.109,P<0.01)、右室内径(OR=1.105,95%CI:1.029~1.186,P<0.01)是PH-LHD独立危险因素。轻度PH-LHD患者与重度PH-LHD患者在心率、肺动脉收缩压(PASP)、呼吸困难、水肿、纳差、利尿剂类和醛固酮受体拮抗剂(MRA)类药物的使用上存在显著差异(P<0.05)。结论:年龄、右室内径是PH-LHD的独立危险因素;重度PH-LHD患者在心率增快、PASP升高、呼吸困难、水肿、纳差方面较轻度PH-LHD患者更加明显。且重度PH-LHD患者和合并≥3种左心疾病的患者PASP升高更加明显。Objective:To study the clinical characteristics of risk factors and severity of pulmonary hypertension due to left heart disease and provide a reference for diagnosis,treatment,and prognosis of the disease.Methods:A retrospective case-control study was conducted.We selected 314 inpatients in the Department of Cardiology of the First Affiliated Hospital of Baotou Medical College from May 2018 to May 2020.Among these patients,134 patients with pulmonary hypertension due to left heart disease were taken as the case group,and 180 patients with left heart disease without pulmonary hypertension were taken as the control group.Logistic regression analysis was used to determine the risk factors of pulmonary hypertension due to left heart disease and the patients’clinical characteristics with different severity.Results:A total of 314 cases were collected,including 134(42.7%)patients with pulmonary hypertension due to left heart disease,including 68(50.7%)males,34(25.4%)with smoking history,31(23.1%)with diabetes history,50(37.3%)with atrial fibrillation,83(62.0%)with hypertension and 82(61.2%)NYHA gradeⅢandⅣ.Binary Logistic regression analysis showed that age(OR=1.073,95%CI:1.038~1.109,P<0.01)and right ventricular diameter(OR=1.105,95%CI:1.029~1.186,P<0.01)were independent risk factors of PH-LHD.There were significant differences in heart rate,PASP,dyspnea,edema,anorexia,diuretics and MRA drugs between mild PH-LHD patients and severe PH-LHD patients(P<0.05).Conclusion:Age and right ventricular diameter are independent risk factors of PH-LHD.Heart rate,PASP,dyspnea,edema and anorexia in patients with severe PH-LHD are more obvious than those in patients with mild PH-LHD.And PASP in patients with severe PH-LHD and patients with≥3 left heart diseases increased more obviously.

关 键 词：左心疾病相关性肺动脉高压 危险因素 病变严重程度 

分 类 号：R544.1[医药卫生—心血管疾病]