成人继发孔房间隔缺损伴肺动脉高压的影响因素分析  

Analysis of influencing factors of secundum atrial septal defect and pulmonary hypertension in adults

作　　者：姜欣 王文婷 柴虹 张志辉 宋治远 廖品亮 Jiang Xin;Wang Wenting;Chai Hong;Zhang Zhihui;Song Zhiyuan;Liao Pinliang(Department of Cardiovascular Medicine,the First Affiliated Hospital of the Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院心血管内科,重庆400038 [2]陆军军医大学(第三军医大学)第一附属医院超声诊断科,重庆400038

出　　处：《临床内科杂志》2023年第7期457-460,共4页Journal of Clinical Internal Medicine

基　　金：国家重点研发计划(2016YFC0900904)。

摘　　要：目的探讨成人继发孔房间隔缺损(ASD)伴肺动脉高压(PH)的影响因素。方法纳入成功接受ASD封堵术的患者167例,根据平均肺动脉压(mPAP)将其分为PH组(mPAP≥25 mmHg)56例和对照组(mPAP<25 mmHg)111例。比较两组患者的一般临床资料、右心导管检查(RHC)、超声心动图检查及十二导联心电图检查结果。相关性分析采用pearson相关分析和二元logistic回归分析。采用受试者工作特征(ROC)曲线评估ASD直径与V1-QRSt诊断ASD伴PH的价值。结果PH组年龄、肺动脉收缩压(PSAP)、肺动脉舒张压(PADP)、mPAP、ASD直径、V1导联QRS波群时限(V1-QRSt)、右束支阻滞(RBBB)及原发性高血压病患者比例均高于对照组(P<0.05)。二元logistic回归分析结果显示,ASD直径为ASD患者发生PH的独立影响因素,ASD直径越大,肺动脉压升高的风险越大(P=0.004)。Spearman相关分析结果显示,ASD直径与V1-QRSt呈正相关(P<0.001)。ROC曲线分析结果显示,V1-QRSt及ASD直径诊断ASD伴PH的曲线下面积(AUC)分别为0.826、0.808,两项指标的诊断效能接近,二者比较差异无统计学意义(P>0.05)。结论ASD直径是ASD患者发生PH的独立影响因素,临床同时应当注重V1-QRSt的诊断价值。Objective To investigate the influencing factors of secundum atrial septal defect(ASD)with pulmonary hypertension(PH)in adults.Methods A total of 167 patients who successfully received ASD occlusion were included and divided into PH group(56 patients with mPAP≥25 mmHg)and control group(111 patients with mPAP<25 mmHg)according to mean pulmonary artery pressure(mPAP).The general clinical data,result of right heart catheterization(RHC),echocardiography and 12-lead electrocardiogram were compared between the two groups.Pearson correlation analysis and binary logistic regression analysis were used for correlation analysis.Receiver operating characteristic(ROC)curve was used to evaluate the value of ASD diameter and V1-QRSt in diagnosing ASD with PH.Results Age,pulmonary systolic blood pressure(PSAP),pulmonary diastolic blood pressure(PADP),mPAP,ASD diameter,V1 lead QRS duration(V1-QRST),right bundle branch block(RBBB),essential hypertension in PH group were higher than those in control group(P<0.05).Binary logistic regression analysis showed that ASD diameter was an independent factor affecting PH in patients with ASD,and the larger the ASD diameter,the greater the risk of elevated pulmonary artery pressure(P=0.004).Spearman correlation analysis showed that ASD diameter was positively correlated with V1-QRSt(P<0.001).ROC curve analysis results showed that the area under the curve(AUC)of V1-QRSt and ASD diameter for diagnosing ASD with PH was 0.826 and 0.808 respectively,the diagnostic efficiency of the two indexes was similar,and there was no statistical significance between them(P>0.05).Conclusion ASD diameter is an independent factor affecting PH in patients with ASD,and clinical attention should be paid to the diagnostic value of V1-QRSt at the same time.

关 键 词：房间隔缺损直径 继发孔房间隔缺损 肺动脉高压 QRS波群时限 

分 类 号：R540.4[医药卫生—心血管疾病] R543.2[医药卫生—内科学]