肥厚型心肌病继发肺动脉高压预测模型的研究  

Analysis of predictive model of pulmonary hypertension secondary to hypertrophic cardiomyopathy

作　　者：娜孜拉·努尔兰 迪丽努尔·买买提依明[1] 吾拉尔·阿德力 阿提开木·吾布力[2] 唐雍淇 Nazila NUERLAN;Dilinuer MAIMAITIYIMING;Wulaer ADELI;Atikaimu WUBULI;TANG Yong-qi(Department of General Cardiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Xinjiang Medical University,School of Public Health,Urumqi 830001,China)

机构地区：[1]新疆医科大学第一附属医院综合心脏内科,新疆维吾尔自治区乌鲁木齐市830011 [2]新疆医科大学公共卫生学院,新疆维吾尔自治区乌鲁木齐市830011

出　　处：《中国心血管病研究》2023年第4期346-351,共6页Chinese Journal of Cardiovascular Research

基　　金：自治区重点研发计划项目(2022B02005-3)。

摘　　要：目的 研究肥厚型心肌病(HCM)患者发生肺动脉高压的独立危险因素并构建肺动脉高压预测模型。方法 选取2016年1月至2021年12月就诊于新疆医科大学第一附属医院并住院诊治的HCM患者157例,根据肺动脉收缩压估算结果,将合并肺动脉高压的患者分为病例组(n=57),将不合并肺动脉高压的患者分为对照组(n=100),并根据肥厚部位不同,将病例组分为室间隔肥厚组(n=35)及心尖肥厚组(n=22)。收集并分析所有患者的一般资料、既往病史、血清学及心脏超声参数,采用单因素及多因素二元logistic回归分析得出HCM患者发生PH的独立危险因素,构建HCM继发PH的预测模型并绘制ROC曲线验证其预测效能。结果 与对照组相比,病例组的N末端B型利钠肽原(NT-proBNP)更高、左心房及右心房内径更大、左心室后壁更厚、肺动脉内径更宽,且射血分数更低[346(78,1019.5)pg/ml比150(80,662.5)pg/ml;(42.49±6.40)mm比(38.18±5.81)mm;(35.70±4.21)mm比(33.50±3.06)mm;(11.30±2.15)mm比(10.35±1.70)mm;(25.75±3.32)mm比(21.99±1.94)mm;(61.77±5.18)%比(63.55±4.38)%;P<0.05]。与心尖肥厚组相比,室间隔肥厚组的NT-proBNP更高、左心房及右心房内径更大、心输出量更低且二尖瓣E/e′值更高[443.9(151,1490)pg/ml比91.35(73.25,450.2)pg/ml;(43.31±5.79)mm比(41.18±7.21)mm;(36.82±4.75)mm比(35.00±3.74)mm;(4.83±1.48)L/min比(5.34±1.13)L/min;(11.32±5.90)比(9.08±3.28),P<0.05],两组患者在肺动脉内径及肺动脉收缩压组间比较中差异无统计学意义(P>0.05)。单因素回归分析提示,左心房内径、右心房内径、左心室后壁厚度、肺动脉内径及射血分数是HCM患者发生肺动脉高压的影响因素,将上述指标进行多因素logistic回归分析后显示,肺动脉内径(OR=1.891,95%CI 1.482~2.412,P<0.001)及射血分数(OR=0.848,95%CI 0.784~0.917,P<0.001)与HCM患者发生PH独立相关。利用该结果建立HCM继发PH的预测模型,模型敏感度77.4%,特异度75.8%,预测�Objective To explore the independent risk factors for pulmonary hypertension in patients with hypertrophic cardiomyopathy and establish a PH prediction model.Methods A collection of 157 hypertrophic cardiomyopathy patients who were hospitalized in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2021 were selected.According to the estimation results of pulmonary artery systolic pressure,patients with pulmonary hypertension were as the case group(n=57)and those without pulmonary hypertension were as the control group(n=100).According to different hypertrophic sites,the case groups were divided into VSHCM group(n=35)and AHCM group(n=22).The general data,past medical history,serology and cardiac ultrasound parameters of all the patients were collected and analyzed.Single factor and multi factor binary logistic regression analysis were used to obtain the independent risk factors of HCM patients with PH.Building a predictive model of PH secondary to HCM.The ROC curve was drawn to verify its predictive effectiveness.Results Compared with the control group,patients in the case group had higher NT-proBNP,larger left and right atrial diameters,thicker left ventricular posterior wall,wider pulmonary artery diameters,and lower LVEF[346(78,1019.5)pg/ml vs.150(80,662.5)pg/ml;(42.49±6.40)mm vs.(38.18±5.81)mm;(35.70±4.21)mm vs.(33.50±3.06)mm;(11.30±2.15)mm vs.(10.35±1.70)mm;(25.75±3.32)mm vs.(21.99±1.94)mm;(61.77±5.18)%vs.(63.55±4.38)%;P<0.05].Compared with patients in AHCM group,patients in VSHCM group had higher NT-proBNP,larger left and right atrial diameters,lower cardiac output and higher mitral valve E/e′value[443.9(151,1490)pg/ml vs.91.35(73.25,450.2)pg/ml;(43.31±5.79)mm vs.(41.18±7.21)mm;(36.82±4.75)mm vs.(35.00±3.74)mm;(4.83±1.48)L/min vs.(5.34±1.13)L/min;(11.32±5.90)vs.(9.08±3.28),P<0.05].There was no significant difference between the two groups in pulmonary artery diameter and pulmonary artery systolic pressure(P>0.05).Univariate regression analysis showe

关 键 词：肺动脉高压 肥厚型心肌病 肺动脉内径 心肌肥厚部位 

分 类 号：R542.2[医药卫生—心血管疾病]