三尖瓣反流速度评估肺动脉高压患者心脏结构改变的研究  

Evaluation of cardiac structural changes in patients with pulmonary hypertension by tricuspid regurgitation velocity

作　　者：吴欣 袁晓晨[1] 沈慧 秦建华 Wu Xin;Yuan Xiaocheng;Shen Hui;Qin Jianhua(Department of Cardiovascular Medicine,Yangzhou University Hospital,Yangzhou 225000,China)

机构地区：[1]扬州大学附属医院心血管内科,江苏扬州225000

出　　处：《中华临床医师杂志（电子版）》2024年第3期259-267,共9页Chinese Journal of Clinicians(Electronic Edition)

基　　金：江苏省自然科学基金青年基金项目(BK20210142);国家自然科学基金资助项目(82100428)。

摘　　要：目的探讨不同水平三尖瓣反流速度(TV)的肺动脉高压患者临床危险因素的相关性。方法选取2021年在扬州大学附属医院就诊于心内科的住院患者,其心脏彩超结果提示三尖瓣反流速度>280 cm/s(TV>280 cm/s)的肺动脉高压患者101例并根据三尖瓣反流速度分为低TV组(TV<300 cm/s)和高TV组(TV>300 cm/s)对比分析2组患者临床特征、血常规、肾功能、血脂分析、甲状腺功能、血气分析、凝血功能、心脏彩超结果的差异,采用Logistic二元回归分析不同水平三尖瓣反流速度的肺动脉高压患者的危险因素及相关性,ROC曲线评估左心房、右心室大小的预测价值及效能。结果高TV组心衰的患病率显著高于低TV组,低TV组HDL、载脂蛋白A水平明显高于高TV组(P<0.05),低TV组左心房、右心室直径平均值小于高TV组,此差异有统计学意义(P<0.05);相关性分析:TV与左心房直径、右心室直径呈正相关(P<0.01),和HDL水平、载脂蛋白A水平呈负性相关(P<0.05);Logistic二元回归分析:患有心力衰竭、左心房扩大、右心室扩大(P<0.05)是肺动脉高压发病的独立危险因素,载脂蛋白A水平升高(P<0.05)是肺动脉高压发病的保护性因子。AUC曲线分析:左心房直径预测肺动脉高压的曲线下面积为0.640(P<0.05),左心房直径的敏感度为47.1%、特异度为79.6%。右心室直径水平预测肺动脉高压的曲线下面积为0.643(P<0.05),右心室直径的敏感度为56.9%、特异性为69.4%,具有统计学意义(P<0.05)。联合预判AUC为0.643,特异性为83.7%,具有统计学意义(P<0.05)。结论肺动脉高压患者其三尖瓣反流速度越大,更容易导致心脏结构改变,往往导致左心房及右心室扩大,临床诊疗时关注三尖瓣反流速度,及早发现心室重构并进行干预,可改善肺动脉高压患者的预后。Objective To investigate the correlation of clinical risk factors in pulmonary hypertension patients with different levels of tricuspid regurgitation velocity.Methods Inpatients admitted to the Department of Cardiology of the Affiliated Hospital of Yangzhou University in 2021 were selected.The results of cardiac color ultrasound indicated that 101 patients with pulmonary hypertension had a tricuspid regurgitation velocity>280 cm/s(TV>280 cm/s),and they were divided into a low TV group(TV<300 cm/s)and a high TV group(TV>300 cm/s)according to the tricuspid regurgitation velocity.The clinical characteristics,routine blood parameters,renal function,and lipid panel were compared between the two groups.The risk factors for pulmonary hypertension and the correlation of pulmonary hypertension with tricuspid regurgitation velocity at different levels were analyzed by Logistic binary regression.The predictive value and efficacy of left atrium and right ventricle size were evaluated by receiver operating characteristic(ROC)curve analysis.Results The prevalence of heart failure in the high TV group was significantly higher than that of the low TV group.The levels of high-density lipoprotein(HDL)and apolipoprotein A in the low TV group were significantly higher than those of the high TV group(P<0.05).The mean diameter of the left atrium and right ventricle in the low TV group was significantly lower than that of the high TV group(P<0.05).TV was positively correlated with the diameter of the left atrium and right ventricle(P<0.01),and negatively correlated with the levels of HDL and apolipoprotein A(P<0.05).Logistic binary regression analysis showed that heart failure,left atrial enlargement,and right ventricular enlargement(P<0.05)were independent risk factors for pulmonary hypertension,and elevated apolipoprotein A level(P<0.05)was a protective factor for pulmonary hypertension.ROC curve analysis showed that the area under the ROC curve(AUC)of left atrial diameter for predicting pulmonary hypertension was 0.640(P<0.05),with

关 键 词：肺动脉高压 超声心动图 三尖瓣反流速度 

分 类 号：R543.2[医药卫生—心血管疾病]