肺动脉高压患者波生坦联合西地那非治疗后右心房功能反应性及其与临床预后的相关性  

Functional Reactivity of Right Atrium after Treatment of Bosentan Combined with Sildenafil in Patients with Pulmonary Hypertension and Its Correlation with Clinical Prognosis

作　　者：朱晓宇 赵庆禧 柏太柱 杨继贺 宾建国 周灵芝 ZHU Xiaoyu;ZHAO Qingxi;BAI Taizhu;YANG Jihe;BIN Jianguo;ZHOU Lingzhi(Department of Cardiology,Hengyang Central Hospital,Hengyang,Hunan 421001,China)

机构地区：[1]衡阳市中心医院心血管内科,湖南衡阳421001

出　　处：《岭南心血管病杂志》2025年第1期58-62,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨肺动脉高压患者应用波生坦联合西地那非治疗后右心房功能反应性及其与临床预后的相关性。方法前瞻性纳入2018年1月至2021年1月在衡阳市中心医院接受波生坦联合西地那非治疗的112例肺动脉高压患者,根据患者预后情况将患者分为预后良好组和预后不良组。使用Cox回归分析评估肺动脉高压患者右心房功能与临床预后的相关性。结果治疗后,患者右心房峰值纵向应变(peak longitudinal strain,PLS)、峰值主动收缩应变(peak active contraction strain,PACS)降低,被动应变(passive strain,PS)升高,但PLS、PACS治疗前后比较,差异无统计学意义(P>0.05)。112例肺动脉高压患者在为期1年的随访中失访9例,最终纳入研究103例,其中34例患者发生预后不良,作为预后不良组,69例未发生预后不良的患者作为预后良好组;两组患者治疗后PLS、PACS以及ΔPLS、ΔPS、ΔPACS比较,差异均有统计学意义(P<0.05)。COX回归分析显示,治疗后高PLS(HR=2.323)是肺动脉高压患者不良临床预后的危险因素(P<0.05),高ΔPLS(HR=0.353)是肺动脉高压患者不良临床预后的保护因素(P<0.05)。结论波生坦联合西地那非治疗肺动脉高压后,患者右心房功能均改善,且治疗后PLS、ΔPLS与患者预后显著相关。Objectives To study the functional reactivity of right atrium in patients with pulmonary hypertension after treatment of Bosentan combined with sildenafil and its correlation with clinical prognosis.Methods Totally 112 patients with pulmonary hypertension who received Bosentan combined with sildenafil in Hengyang Central Hospital from January 2018 to January 2021 were prospectively included.According to the prognosis of the patients,the patients were divided into good prognosis group and poor prognosis group.Cox regression analysis was used to evaluate the correlation between right atrial function and clinical prognosis in patients with pulmonary hypertension.Results After treatment,peak longi⁃tudinal strain(PLS)and peak active contraction strain(PACS)decreased and passive strain(PS)increased,but there were no significant differences between PLS and PACS before and after treatment(P>0.05).Nine of the 112 patients with pulmonary hypertension were lost in a one-year follow-up,and 103 patients were finally included in the study,of which 34 patients had poor prognosis as a poor prognosis group and 69 patients without poor prognosis as a good prognosis group.There were significant differences in PLS,PACS andΔPLS,ΔPS andΔPACS between the two groups after treatment(P<0.05).COX regression analysis showed that high PLS(HR=2.323)after treatment was a risk factor for poor clinical prognosis of patients with pulmonary hypertension(P<0.05),and highΔPLS(HR=0.353)was a protective factor for poor clinical prognosis of patients with pulmonary hypertension(P<0.05).Conclusions Bosentan combined with sildenafil can improve the right atrial function of patients with pulmonary hypertension,and PLS andΔPLS are significantly related to the prognosis of patients after treatment.

关 键 词：肺动脉高压 右心房功能 波生坦 西地那非 

分 类 号：R543.2[医药卫生—心血管疾病]