心脏超声评估右心功能对结缔组织病相关间质性肺病继发肺动脉高压的预测价值  

Predictive value of right heart function in diagnosing pulmonary hypertension secondary to connective tissue disease⁃associated interstitial lung disease by echocardiography

作　　者：梁金 金承基 黄含音 王乐华[3] 陈维飞 Liang Jin;Jin Chengji;Huang Hanyin;Wang Lehua;Chen Weifei(Department of Rheumatism and Immunology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570100,China)

机构地区：[1]海南医学院第二附属医院风湿免疫科,海口570100 [2]海南医学院第二附属医院呼吸内科,海口570100 [3]海南医学院第二附属医院超声医学科,海口570100

出　　处：《临床内科杂志》2025年第1期25-29,共5页Journal of Clinical Internal Medicine

基　　金：海南省卫生健康行业科研项目(21A200236)。

摘　　要：目的探讨结缔组织病相关间质性肺病(CTD⁃ILD)继发肺动脉高压(PH)的临床特点及右心功能参数对疾病的预测价值。方法根据是否诊断为PH将140例CTD⁃ILD患者分为ILD⁃PH组(28例)和ILD⁃non⁃PH组(112例)。收集所有患者的一般资料、临床表现、CTD⁃ILD疾病构成情况、首次入院实验室检查结果、肺部影像学特征表现及经胸超声心动图(TTE)检查结果并进行组间比较。相关因素分析采用单因素和多因素logistic回归分析。预测价值采用受试者工作特征(ROC)曲线评估。结果CTD⁃ILD⁃PH的发生率为20.0%。ILD⁃PH组血清铁蛋白(SF)、N末端B型利钠肽前体(NT⁃proBNP)水平、三尖瓣反流峰值速度(TRV)、右心室基底段内径(RVD2)/左心室基底段内径(LVD)、舒张早期肺动脉反流速度(PRVBD)及活动后气短、雷诺现象、肺Velcro啰音、影像学特征表现为牵拉性支气管扩张患者比例均明显高于ILD⁃non⁃PH组,右室流出道多普勒加速时间(RVOT⁃AT)明显低于ILD⁃non⁃PH组(P<0.05)。多因素logistic回归分析结果显示,RVD2/LVD升高和RVOT⁃AT降低均是CTD⁃ILD进展为CTD⁃ILD⁃PH的独立危险因素(P<0.05)。ROC曲线分析结果显示,RVD2/LVD及RVOT⁃AT预测CTD⁃ILD进展为CTD⁃ILD⁃PH的曲线下面积(AUC)分别为0.809及0.850。结论TTE早期评估右心功能参数对CTD⁃ILD患者继发PH有预测价值,其中RVD2/LVD升高和RVOT⁃AT下降是CTD⁃ILD⁃PH的独立危险因素。Objective To explore the clinical characteristics of pulmonary hypertension(PH)secondary to connective tissue disease⁃associated interstitial lung disease(CTD⁃ILD)and the predictive value of the disease.Methods The patients were divided into ILD⁃PH group(28 cases)and ILD⁃non⁃PH group(112 cases)based on their PH diagnosis.Clinical data,CTD⁃ILD disease composition,first admission lab examination results,lung imaging features and transthoracic echocardiography(TTE)result were analyzed and compared between the two groups.The correlation factors were analyzed by univariate and multivariate logistic regression analyses.Predictive value were evaluated by receiver operating characteristics(ROC)curves.Results The incidence of CTD⁃ILD⁃PH was 20.0%.Serum ferritin(SF),N⁃terminal B⁃type natriuretic peptide precursor(NT⁃proBNP)levels,peak tricuspid valve regurgitant velocity(TRV),right ventricular basal diameter(RVD2)/left ventricular basal diameter(LVD),early diastolic pulmonary artery regurgitant velocity(PRVBD)and the proportion of patients with Shortness of breath after activity,Raynaud’s phenomenon,lung Velcro rales,the imaging features were tractive bronchiectasis in ILD⁃PH group were significantly higher while right ventricular outflow channel doppler acceleration time(RVOT⁃AT)was lower compared to the ILD⁃non⁃PH group(P<0.05).Multivariate logistic regression analysis results showed that elevated RVD2/LVD and decreased RVOT⁃AT were independent risk factors for progression to CTD⁃ILD⁃PH in CTD⁃ILD(P<0.05).ROC curve analysis results showed that the area under the curve(AUC)of RVD2/LVD and RVOT⁃AT predicting progression to CTD⁃ILD⁃pH in CTD⁃ILD were 0.809 and 0.850,respectively.Conclusion An early assessment of right heart function parameters by TTE can help predict PH in CTD⁃ILD patients.Elevated RVD2/LVD and decreased RVOT⁃AT are independent risk factors for CTD⁃ILD⁃PH.

关 键 词：结缔组织病 肺动脉高压 间质性肺病 经胸超声心动图 

分 类 号：R593.2[医药卫生—内科学]