血流储备分数对慢性血栓栓塞性肺动脉高压患者肺动脉血流动力学的评估价值  

The assessment value of fractional flow reserve for hemodynamics in patients with chronic thromboembolic pulmonary hypertension

作　　者：王金志 吴一凡 陶新曹 谢万木 张帅 张云霞 张竹 张宇 刘吉祥 席霖枫 李宜珊 高倩 黄强 翟振国 Wang Jinzhi;Wu Yifan;Tao Xincao;Xie Wanmu;Zhang Shuai;Zhang Yunxia;Zhang Zhu;Zhang Yu;Liu Jixiang;Xi Linfeng;Li Yishan;Gao Qian;Huang Qiang;Zhai Zhenguo(Jiangxi Provincial Key Laboratory of Respiratory Diseases/Jiangxi Institute of Respiratory Diseases/Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital/Jiangxi Medical College of Nanchang University,Jiangxi Nanchang 330006;Department of Respiratory and Critical Care Medicine,Jiangxi Hospital of China-Japan Friendship Hospital,Jiangxi Nanchang 330052;Fuwai Hospital Center for Respiratory and Pulmonary Vascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037;State Key Laboratory of Respiratory Health and Multimorbidity,National Center for Respiratory Medicine/Respiratory Medicine Institute,Chinese Academy of Medical Sciences/Department of Pulmonary and Critical Care Medicine of Respiratory Medicine Center,China-Japan Friendship Hospital,Beijing 100029;Graduate School,Shanxi Medical University,Shanxi Taiyuan 030001,China)

机构地区：[1]江西省呼吸疾病重点实验室,江西省呼吸疾病研究所,南昌大学第一附属医院呼吸与危重症医学科,南昌大学江西医学院,江西南昌330006 [2]中日友好医院江西医院呼吸与危重症医学科,江西南昌330052 [3]中国医学科学院阜外医院呼吸与肺血管病中心,北京100037 [4]国家呼吸医学中心呼吸和共病全国重点实验室,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心呼吸与危重症医学科,北京100029 [5]山西医科大学研究生学院,山西太原030001

出　　处：《中华介入放射学电子杂志》2025年第1期18-22,共5页Chinese Journal of Interventional Radiology:electronic edition

基　　金：中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-01-01-02);江西省卫生健康委科技计划项目(202510276);中国医学科学院医学与健康科技创新工程(2021-12M-1-049)。

摘　　要：目的探讨压力导丝测得血流储备分数(fractional flow reserve,FFR)在慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)中的应用价值。方法连续纳入2022年2至8月于中日友好医院呼吸与危重症医学科诊治的CTEPH患者的临床资料。本研究纳入患者接受当次球囊肺动脉成形术(balloon pulmonary angioplasty,BPA)前均通过压力导丝测得FFR,对该病变血管进行选择性肺动脉造影评估肺动脉血流分级(pulmonary flow grade,PFG)。收集患者基线资料及血流动力学参数,并对病变肺动脉分别进行FFR和PFG相关性分析。结果在18例患者的21支血管中,FFR为0.67±0.19,平均肺动脉压(mean pulmonary arterial pressure,mPAP)为(33±7.6)mmHg,心排(cardiac output,CO)为(3.7±1.2)L/min,肺血管阻力(pulmonary vascular resistance,PVR)为(7.3±3.5)WU,混合静脉血氧饱和度为68.7%±7.1%,血浆N-末端脑钠肽前体为191.3(82.23,290.25)pg/mL,世界卫生组织心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级分级分别为2(11.1%)、14(77.8%)、2(11.1%)、0(0.0%),6 min步行距离为(442.2±83.5)米。血管分布特点:左肺8支血管均在左肺下叶;右肺13支血管,右肺上叶5支(38.5%),右肺中叶1支(7.7%),右肺下叶7支(53.8%)。肺动脉血流分级:0级血流1支(4.8%),1级血流3支(14.3%),2级血流3支(14.3%),3级血流14支(66.6%)。PFG与FFR有显著相关性(r=0.937;P<0.0001)。结论在CTEPH患者中,通过压力导丝测量获得FFR可用于指导CTEPH患者的BPA治疗,是一种有效、精准的评价方法。Objective This study aims to explore the accuracy of fractional flow reserve(FFR)measured by pressure wire at the proximal and distal ends of the lesion in chronic thromboembolic pulmonary hypertension.Methods This study consecutively enrolled patients(21 pulmonary arteries)with CTEPH who received BPA treatment at the Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,between February 2022 and August 2022.The FFR in the pulmonary arteries was measured using pressure wires,and PFG was calculated through selective pulmonary angiography.Correlation analysis was performed among FFR,PFG.Results In total,18 patients with CTEPH were included in the study,including 11(61.1%)male and 7(38.9%)female patients,with an average age of 60.1±10.5 years.In the 21 vessels of 18 patients,the FFR was 0.67±0.19.Vascular Distribution Characteristics:left lung:8 blood vessels,all located in the left lower lobe.right lung:13 blood vessels,distributed as follows:right upper lobe:5 vessels(38.5%),right middle lobe:1 vessel(7.7%),right lower lobe:7 vessels(53.8%).Pulmonary Artery Blood Flow Classification:grade 0 blood flow:1 vessel(4.8%),grade 1 blood flow:3 vessels(14.3%),grade 2 blood flow:3 vessels(14.3%),grade 3 blood flow:14 vessels(66.6%).The results showed that there was a significant correlation between PFG and FFR(R=0.937,P<0.0001).Conclusion Fractional flow reserve(FFR)was an effective and precise evaluation method.It obtained via pressure wire measurement can guide balloon pulmonary angiography(BPA)treatment for CTEPH patients.

关 键 词：慢性血栓栓塞性肺动脉高压 球囊肺动脉成形术 肺动脉内膜剥脱术 血流储备分数 肺动脉血流分级 

分 类 号：R543.2[医药卫生—心血管疾病]