肺动脉血流分级评估肺动脉球囊成形术治疗慢性血栓栓塞性肺动脉高压的临床疗效的研究  

Value of Pulmonary Flow Grade Evaluation on Defining the Clinical Efficacy of Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension

作　　者：赵智慧 李欣 罗勤 赵青 杨涛 曾绮娴 熊长明 张毅 柳志红 ZHAO Zhihui;LI Xin;LUO Qin;ZHAO Qing;YANG Tao;ZENG Qixian;XIONG Changming;ZHANG Yi;LIU Zhihong(Center for Respiratory and Pulmonary Vascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院国家心血管病中心、阜外医院呼吸与肺血管疾病诊治中心,北京100037

出　　处：《中国循环杂志》2023年第7期756-760,共5页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-055、2021-I2M-C&T-B-032);中央高水平医院临床科研业务费(2022-GSP-GG-35);北京市自然科学基金(7202168)。

摘　　要：目的:利用肺动脉血流分级评估肺动脉球囊成形术(BPA)治疗慢性血栓栓塞性肺动脉高压的临床疗效。方法:连续入选2018年10月至2022年2月在中国医学科学院阜外医院呼吸与肺血管疾病诊治中心接受BPA治疗的慢性血栓栓塞性肺动脉高压患者153例,观察患者术后随访时肺动脉血流分级的改善情况,并评估其与肺动脉血液动力学、右心功能改善的相关性及其对BPA疗效的预测价值。结果:术后中位随访10(4,18)个月,患者的平均肺动脉压[(38.22±10.20)mmHg vs.(50.12±11.72)mmHg,1 mmHg=0.133 kPa]、峰值耗氧量[(14.63±3.65)ml/(min·kg)vs.(12.29±3.53)ml/(min·kg)]、肺动脉血流分级总分[(29.88±15.80)分vs.(11.31±7.29)分]较术前均明显改善(P均<0.001)。Spearman相关性分析显示,肺动脉血流分级的改善与平均肺动脉压、三尖瓣反流速度、6分钟步行距离的改善显著相关(P均<0.05)。多因素Logistic回归分析显示,校正混杂因素后,肺动脉血流分级的变化可独立预测BPA疗效(OR=0.946,95%CI:0.910~0.983,P=0.005)。结论:BPA能够显著改善慢性血栓栓塞性肺动脉高压患者的肺动脉血流分级。肺动脉血流分级的改善与肺动脉血液动力学、右心功能的改善密切相关,能够独立预测BPA疗效。Objectives:We aims to explore the feasibility of evaluating the efficacy of balloon pulmonary angioplasty(BPA)by pulmonary flow grade in patients with chronic thromboembolic pulmonary hypertension.Methods:A total of 153 consecutive patients with chronic thromboembolic pulmonary hypertension who received BPA in Center for Respiratory and Pulmonary Vascular Diseases in Fuwai Hospital from October 2018 to February 2022 were enrolled in this study.Correlations between changes on pulmonary flow grade and pulmonary hemodynamics and right heart function during follow-up were evaluated,and the predictive value of monitoring pulmonary flow grade on the efficacy of BPA was determined.Results:After a median 10(4,18)months follow-up after BPA,compared with baseline,the mean pulmonary arterial pressure([38.22±10.20]mmHg vs.[50.12±11.72]mmHg,1 mmHg=0.133 kPa),the maximal oxygen uptake([14.63±3.65]ml/[min·kg]vs.[12.29±3.53]ml/[min·kg])and total score of pulmonary flow grade(29.88±15.80 vs.11.31±7.29)were significantly improved after BPA(all P<0.001).Spearman correlation analysis indicated that the improvement of the pulmonary flow grade was associated with the improvement of mean pulmonary arterial pressure,tricuspid regurgitation velocity and the 6-minute walking distance(all P<0.05).Multivariable logistic regression demonstrated that the change of the pulmonary flow grade could independently predict BPA efficacy after adjusting for confounders(OR=0.946,95%CI:0.910-0.983,P=0.005).Conclusions:BPA could improve the pulmonary flow grade significantly.The improvement of pulmonary flow grade after BPA is associated with improvement of pulmonary hemodynamics and right heart function,and could independently predict the efficacy of BPA in patients with chronic thromboembolic pulmonary hypertension.

关 键 词：肺动脉血流分级 慢性血栓栓塞性肺动脉高压 肺动脉球囊成形术 疗效 

分 类 号：R54[医药卫生—心血管疾病]