肺动脉与主动脉直径比对急性失代偿性心力衰竭患者预后的影响  

Effect of pulmonary artery to aorta diameter ratio on prognosis in patients with acute decompensated heart failure

作　　者：马春梅 吴志康 陈可 王紫艳 王钰 王涟 MA Chunmei;WU Zhikang;CHEN Ke;WANG Ziyan;WANG Yu;WANG Lian(Department of Cardiology,Nanjing Drum Tower Hospital Clinical College of Jiangsu University,Nanjing 210008,Jiangsu,China;不详)

机构地区：[1]江苏大学鼓楼临床医学院心内科,江苏南京210008 [2]南京大学医学院附属鼓楼医院心内科,江苏南京210008

出　　处：《实用医学杂志》2025年第7期960-967,共8页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:82370267);心力衰竭单病种数据库建设项目(编号:2024-LCYJ-DBZ-03)。

摘　　要：目的探讨肺动脉(Pa)与主动脉(Ao)直径比(Pa/Ao)对急性失代偿性心力衰竭(ADHF)患者远期主要不良心血管事件(MACEs)的预测价值。方法连续纳入2018年1月至2023年1月在南京鼓楼医院心内科住院的ADHF患者,收集性别、年龄、既往史、实验室检查、超声心动图、胸部CT及服用药物等资料。在胸部CT的主肺动脉分叉处测量Pa及Ao直径,计算Pa/Ao。采用Kaplan-Meier法进行生存分析,并使用Log-rank法比较两组间的生存率差异。采用Cox比例风险回归模型分析Pa/Ao与MACEs的关联,对不同的年龄、性别、BMI、B型利钠肽水平、左心室射血分数进行亚组分析。结果共纳入600例ADHF患者,年龄(69.6±14.1)岁,男347例(57.8%)。中位随访306(127,624)d,327例(54.5%)患者发生MACEs。根据最大选择秩统计量分析,MACEs发生的Pa/Ao最佳截断值为0.93,将ADHF人群分为Pa/Ao<0.93组和Pa/Ao≥0.93组。Kaplan-Meier曲线显示,Pa/Ao≥0.93组MACEs发生率显著高于Pa/Ao<0.93组(P_(log-rank)<0.001)。多因素Cox回归分析显示,Pa/Ao是ADHF患者MACEs的独立预测因子(HR=11.62,95%CI:4.91~27.50,P<0.001)。亚组分析表明,Pa/Ao对不同的ADHF人群均存在预测价值(P<0.05)。结论Pa/Ao升高是ADHF患者远期MACEs的预测因子。Objective To investigate the predictive value of pulmonary artery(Pa)to aortic(Ao)diameter ratio(Pa/Ao)for long⁃term major adverse cardiovascular events(MACEs)in patients with acute decompensated heart failure(ADHF).Methods ADHF patients hospitalized in the Department of Cardiology of Nanjing Drum Tower Hospital from January 2018 to January 2023 were consecutively enrolled.The data of gender,age,past medical history,laboratory examination,echocardiography,chest CT and medication were collected.The diameters of Pa and Ao were measured at the bifurcation of main pulmonary artery on chest CT,and Pa/Ao was calculated.The Kaplan⁃Meier method was used for survival analysis,and the Log⁃rank test was used to compare the survival rate between the two groups.Cox proportional hazards regression model was used to analyze the association between Pa/Ao and MACEs,and subgroup analysis was performed according to different age,sex,BMI,B⁃type natriuretic peptide level,and left ventricular ejection fraction.Results A total of 600 ADHF patients were enrolled,with an average age of 69.6 years and 347(57.8%)males.During a median follow⁃up of 306(127,624)days,327(54.5%)patients experienced MACEs.The ADHF patients were divided into Pa/Ao<0.93 group and Pa/Ao≥0.93 group according to the analysis of maximum selection rank statistics.Kaplan⁃Meier curve showed that the incidence of MACEs in Pa/Ao≥0.93 group was significantly higher than that in Pa/Ao<0.93 group(PLog⁃rank<0.001).Multivariate Cox regression analysis showed that Pa/Ao was an independent predictor of MACEs in ADHF patients(HR=11.62,95%CI:4.91~27.50,P<0.001).Subgroup analysis showed that Pa/Ao had predictive value for different ADHF populations(all P<0.05).Conclusion Elevated Pa/Ao is a predictor of long⁃term MACEs in ADHF patients.

关 键 词：急性失代偿性心力衰竭 肺动脉与主动脉直径比 CT检查 预后 

分 类 号：R54[医药卫生—心血管疾病]