合并肺动脉高压的肥厚型心肌病患者发生不良预后的危险因素  

Effect of combined pulmonary arterial hypertension on the prognosis of hypertrophic cardiomyopathy

作　　者：娜孜拉·努尔兰 唐雍淇 艾尼娃尔·艾克木 迪丽努尔·买买提依明[1] Nazila Nuerlan;Tang Yongqi;Ainiwaer Aikemu;Dilinuer Maimaitiyiming(Dept of General Cardiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011;College of Pharmacy,Xinjiang Hotan University,Hotan 848000)

机构地区：[1]新疆医科大学第一附属医院综合心脏内科,乌鲁木齐830011 [2]新疆和田学院药学院,和田848000

出　　处：《安徽医科大学学报》2025年第2期351-357,共7页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81660695);天山创新团队计划(编号:2020D14032)。

摘　　要：目的研究肥厚型心肌病(HCM)合并肺动脉高压(PH)患者发生不良预后的危险因素。方法选取确诊为HCM的患者(n=154),根据是否合并PH将患者分为对照组(n=119)与病例组(n=35),并对比分析基线及超声心动图资料;再将病例组患者根据肺动脉收缩压(PASP)升高程度分为PH 1组(n=25)及PH 2组(n=10)。对患者进行随访并记录2年内是否发生不良事件,运用Cox回归分析HCM合并PH的患者发生不良预后的危险因素,绘制KM生存曲线进行HCM合并PH患者生存风险分析。结果HCM患者的PH患病率22.73%,与对照组相比,女性(48.57%)及合并心律失常(42.86%)的患者在病例组中占比较大(P<0.01)。对病例组患者进行斯皮尔曼相关性分析提示女性、中重度瓣膜反流与PASP的变化正相关,心房内径、左房室耦联指数、左室质量分数及二尖瓣舒张早期血流速度峰值(E)与二尖瓣环根部舒张早期心肌运动速度峰值(e′)(E/e′)值均可随PASP水平的升高而增加(P<0.05),左室射血分数随PASP水平的增加而降低(P<0.001)。HCM患者不良事件发生率为25.97%,Log Rank检验提示PH 1组与PH 2组患者累计生存率组间差异有统计学意义(P<0.001),Cox回归分析提示,PASP(HR=1.123,95%CI:1.033~1.221)及E/e′值(HR=1.131,95%CI:1.054~1.213)均为合并PH的HCM患者2年内发生不良事件的独立危险因素(P<0.05)。结论PASP水平及E/e′值均为HCM合并PH患者发生不良预后的独立危险因素。Objective To study the risk factors of poor prognosis in patients with hypertrophic cardiomyopathy(HCM)complicated with pulmonary hypertension(PH).Methods Patients(n=154)diagnosed with HCM were selected.According to whether they were complicated with pH,the patients were divided into control group(n=119 cases)and case group(n=35 cases),and the baseline and echocardiographic data were compared and analyzed.Then the patients in the case group were divided into PH 1 group(n=25 cases)and PH 2 group(n=10 cases)according to the degree of elevation of pulmonary artery systolic pressure(PASP).The patients were followed up and recorded whether the patients had adverse events within 2 years.Cox regression analysis was used to analyze the risk factors of poor prognosis in patients with HCM with PH.KM survival curves were plotted for the survival risk analysis of patients with HCM complicated with PH.Results The prevalence of pH in HCM patients was 22.73%.Compared with the control group,women(48.57%)and patients with arrhythmia(42.86%)accounted for a larger proportion in the case group(P<0.01).Spearman correlation analysis of the patients in the case group showed that female,moderate and severe valve regurgitation were positively correlated with the changes of PASP.Atrial diameter,LACI,left ventricular mass fraction and E/e′value all increased with the increase of PASP level(P<0.05),and LVEF decreased with the increase of PASP level(P<0.001).The incidence of adverse events in HCM patients was 25.97%.Log Rank test showed that there was a statistically significant difference in the cumulative survival rate between PH 1 group and PH 2 group(P<0.001).Cox regression analysis showed that PASP(HR=1.123,95%CI=1.033-1.221)and E/e′(HR=1.131,95%CI=1.054-1.213)were independent risk factors for adverse events in HCM patients with PH within 2 years(P<0.05).Conclusion Both PASP levels and E/e′values are independent risk factors for developing poor prognosis in patients of HCM with PH.

关 键 词：肥厚型心肌病 心肌纤维化 肺动脉高压 肺动脉收缩压 心力衰竭 不良事件 

分 类 号：R445.1[医药卫生—影像医学与核医学]