超声心动图右室心肌工作指数对COPD相关性肺动脉高压的评估价值  

Evaluation value of ultrasonic cardiogram right ventricular myocardial performance index for COPD-related pulmonary hypertension

作　　者：夏宗敏 范珺 周泉 濮维纲 XIA Zong-min;FAN Jun;ZHOU Quan;PU Wei-gang(Department of Ultrasound,17th Metallurgical Hospital,Ma'anshan 243000,China)

机构地区：[1]安徽省马鞍山十七冶医院超声科,安徽马鞍山243000

出　　处：《哈尔滨医科大学学报》2022年第3期271-275,共5页Journal of Harbin Medical University

基　　金：安徽省自然科学基金青年项目(1908085QH336)。

摘　　要：目的探究超声心动图右室心肌工作指数(right ventricular myocardial performance index,RVMPI)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)相关性肺动脉高压(COPD-pulmonary hypertension,COPD-PH)的评估价值。方法选择本院2019年4月~2021年5月收治的82例COPD患者作为研究对象,以患者平均肺动脉压(mean pulmonary artery pressure,mPAP)检测结果为金标准,将其分为COPD-PH组(46例)和COPD-nonPH组(36例)。分别检测肺功能指标[包括用力肺活量(forced vital capacity,FVC)、吸入支气管扩张剂后第1 s用力呼气容积(forced expiratory volume in the first second,FEV1)、肺总量(total lung volume,TLV)及残气量(residual volume,RV)]、超声心动图指标[三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、左心室射血分数(left ventricular ejection fraction,LVEF)及RVMPI]及肺动脉血压[肺血管阻力(pulmonary vascular resistance,PVR)、肺小动脉楔压(pulmonary arteriolar wedge pressure,PAWP)及平均肺动脉压(mean pulmonary artery pressure,mPAP)]。以Logistic多因素回归分析探讨影响COPD患者出现COPD-PH的危险因素,以受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)判定RVMPI水平对COPD患者出现COPD-PH的预测价值。结果82例COPD患者中COPD-PH 46例(COPD-PH组),占比56.10%;COPD-nonPH 36例(COPD-nonPH组),占比43.90%。COPD-PH组FVC水平均低于COPD-nonPH组,RVMPI指数、PVR及mPAP水平均低于COPD-nonPH组,差异均具有统计学意义(P<0.05);Logistic回归分析结果显示,RVMPI指数、PVR及mPAP水平均为COPD患者出现COPD-PH的危险因素(P<0.05),FVC为COPD患者出现COPD-PH的保护因素(P<0.05);ROC分析显示,RVMPI指数预测COPD患者出现COPD-PH的灵敏度为82.61%,特异度为72.22%,曲线下面积(area under curve,AUC)为0.840(95%CI:0.759~0.921)。结论PVR水平偏高的COPD患者更易出现COPD-PH,RVMPI指数水平对COPD患者出现COPD-PH具有一定的临床预测效能。Objective To explore the evaluation value of ultrasonic cardiogram right ventricular myocardial performance index(RVMPI)for chronic obstructive pulmonary disease(COPD)related pulmonary hypertension(COPD-PH).Methods A total of 82 patients with chronic obstructive pulmonary disease(COPD)treated in our hospital from April 2019 to May 2021 were selected as the research object.According to the test results of mean pulmonary artery pressure(mPAP),they were divided into COPD-pulmonary hypertension(COPD-PH)group and COPD-nonPH group.The indexes of lung function including forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),total lung volume(TLV)and residual volume(RV)were measured respectively.Ultrasonic cardiogram indexes were detected including tricuspid annular plane systolic excursion(TAPSE),left ventricular ejection fraction(LVEF)and RVMPI,and pulmonary artery blood pressure were detected including pulmonary vascular resistance(PVR),pulmonary arteriolar wedge pressure(PAWP)and mean pulmonary artery pressure(mPAP).The risk factors affecting COPD-PH in COPD patients were analyzed by Logistic multivariate regression analysis,and the predictive value of RVMPI level in COPD patients was determined by receiver operating characteristic(ROC)curve.Results Forty-six COPD-PH patients(COPD-PH group)accounted for 56.10%of the 82 COPD patients,36 COPD-nonPH patients(COPD-nonPH group)accounted for 43.90%.FVC level in COPD-PH group was lower than that in COPD-nonPH group,and RVMPI index,PVR and mPAP level were also lower in COPD-nonPH group,the difference was statistically significant(P<0.05).Logistic regression analysis results showed that RVMPI index,both PVR and mPAP levels were risk factors for COPD-PH in patients with COPD(P<0.05),and FVC was a protective factor for COPD-PH in patients with COPD(P<0.05).ROC analysis showed that the sensitivity of RVMPI index in predicting COPD-PH was 82.61%,the specificity was 72.22%,and the area under curve(AUC)was 0.840(95%CI:0.759~0.921).Conclusion COPD patients wit

关 键 词：超声心动图 右室心肌工作指数 慢性阻塞性肺疾病 肺动脉高压 

分 类 号：R445.1[医药卫生—影像医学与核医学]