-
摘要: 目的:研究左心疾病相关性肺动脉高压(PH-LHD)的危险因素及不同病变严重程度的临床特点,为疾病的诊治及预后判断提供参考。方法:采用回顾性病例对照研究方法,将包头医学院第一附属医院2018年5月—2020年5月于心内科住院的PH-LHD患者134例作为病例组,有左心疾病但未合并肺动脉高压患者180例作为对照组。通过分析寻找PH-LHD形成的危险因素及不同病变严重程度患者的临床特点。结果:共收集病例314例,PH-LHD患者134(42.7%)例,其中男68例(50.7%),有吸烟史34例(25.4%),有糖尿病史31例(23.1%),有心房颤动(房颤)史50例(37.3%),有高血压史83例(62.0%),心功能NYHA分级Ⅲ、Ⅳ级82例(61.2%)。二元Logistic回归分析发现:年龄(OR=1.073,95%CI:1.038~1.109,P<0.01)、右室内径(OR=1.105,95%CI:1.029~1.186,P<0.01)是PH-LHD独立危险因素。轻度PH-LHD患者与重度PH-LHD患者在心率、肺动脉收缩压(PASP)、呼吸困难、水肿、纳差、利尿剂类和醛固酮受体拮抗剂(MRA)类药物的使用上存在显著差异(P<0.05)。结论:年龄、右室内径是PH-LHD的独立危险因素;重度PH-LHD患者在心率增快、PASP升高、呼吸困难、水肿、纳差方面较轻度PH-LHD患者更加明显。且重度PH-LHD患者和合并≥3种左心疾病的患者PASP升高更加明显。
-
关键词:
- 左心疾病相关性肺动脉高压 /
- 危险因素 /
- 病变严重程度
Abstract: Objective: To study the clinical characteristics of risk factors and severity of pulmonary hypertension due to left heart disease and provide a reference for diagnosis, treatment, and prognosis of the disease.Methods: A retrospective case-control study was conducted. We selected 314 inpatients in the Department of Cardiology of the First Affiliated Hospital of Baotou Medical College from May 2018 to May 2020. Among these patients, 134 patients with pulmonary hypertension due to left heart disease were taken as the case group, and 180 patients with left heart disease without pulmonary hypertension were taken as the control group. Logistic regression analysis was used to determine the risk factors of pulmonary hypertension due to left heart disease and the patients' clinical characteristics with different severity.Results: A total of 314 cases were collected, including 134(42.7%) patients with pulmonary hypertension due to left heart disease, including 68(50.7%) males, 34(25.4%) with smoking history, 31(23.1%) with diabetes history, 50(37.3%) with atrial fibrillation, 83(62.0%) with hypertension and 82(61.2%) NYHA gradeⅢ andⅣ. Binary Logistic regression analysis showed that age(OR=1.073, 95%CI: 1.038~1.109, P<0.01) and right ventricular diameter(OR=1.105, 95%CI: 1.029~1.186, P<0.01) were independent risk factors of PH-LHD. There were significant differences in heart rate, PASP, dyspnea, edema, anorexia, diuretics and MRA drugs between mild PH-LHD patients and severe PH-LHD patients(P<0.05).Conclusion: Age and right ventricular diameter are independent risk factors of PH-LHD. Heart rate, PASP, dyspnea, edema and anorexia in patients with severe PH-LHD are more obvious than those in patients with mild PH-LHD. And PASP in patients with severe PH-LHD and patients with ≥3 left heart diseases increased more obviously.-
Key words:
- pulmonary hypertension due to left heart disease /
- risk factors /
- severity
-
-
[1] 赛迪妮萨·如则麦麦提,黄燕,张宇辉.左心疾病相关性肺高血压的研究进展[J].中华心力衰竭和心肌病杂志(中英文),2019,3(2):113-117.
[2] Rosenkranz S,Gibbs JS,Wachter R,et al.Left ventricular heart failure and pulmonary hypertension[J].Eur Heart J,2016,37(12):942-954.
[3] Berthelot E,Bauer F,Eicher JC,et al.Pulmonary hypertension in chronic heart failure:definitions,advances,and unanswered issues[J]. ESC Heart Fail,2018,5(5):755-763.
[4] Galiè N,Humbert M,Vachiery JL.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J].Rev Esp Cardiol(Engl Ed),2016,69(2):177.
[5] Thomas CA,Anderson RJ,Condon DF,et al.Diagnosis and Management of Pulmonary Hypertension in the Modern Era:Insights from the 6th World Symposium[J].Pulm Ther,2020,6(1):9-22.
[6] 郭瑞,武建民,郭禹,等.多层螺旋CT与超声心动图诊断肺动脉高压的比较分析[J].中国CT和MRI杂志,2020,18(7):70-73.
[7] Ni JR,Yan PJ,Liu SD,et al.Diagnostic accuracy of transthoracic echocardiography for pulmonary hypertension:a systematic review and meta-analysis[J].BMJ Open,2019,9(12):e033084.
[8] 李越.肺动脉高压超声心动图诊断须知[G]//中国医师协会超声医师分会.2012中国·北京超声医学学术大会论文汇编,北京:中国医师协会超声医师分会,2012:59-63.
[9] Ramani G,Chen W,Patel S,et al.Noninvasive Assessment of Right Ventricular Function in Patients with Pulmonary Arterial Hypertension and Left Ventricular Assist Device[J].Curr Cardiol Rep,2019,21(8):82.
[10] 廖玉华,杨杰孚,张健,等.舒张性心力衰竭诊断和治疗专家共识[J].临床心血管病杂志,2020,36(1):1-10.
[11] Hanif W,Alex L,Ya S,et al.Left atrial remodeling,hypertrophy andfibrosis in mouse models of heart failure[J].Cardiovasc Pathol,2017,30:27-37.
[12] Zolty R.Challenges in pulmonary hypertension associated with left heart disease[J].Expert Rev Cardiovasc Ther,2019,17(6):461-472.
[13] Quan R,Huang L,Yang T,et al.Prognostic value of hemodynamics and comorbidities in pulmonary hypertension due to advanced heart failure[J].Heart Lung,2020,49(2):158-164.
[14] 崔敏珺,李从圣,杨静.高血压患者发生射血分数保留心衰的危险因素分析[J].医学信息,2019,32(20):72-76.
[15] Colin GC,Verlynde G,Pouleur AC,et al.Pulmonary hypertension due to left heart disease:diagnostic value of pulmonary artery distensibility[J].Eur Radiol,2020,30(11):6204-6212.
[16] Tampakakis E,Shah SJ,Borlaug BA,et al.Pulmonary Effective Arterial Elastance as a Measure of Right Ventricular Afterload and Its Prognostic Value in Pulmonary Hypertension Due to Left Heart Disease[J].Circ Heart Fail,2018,11(4):e004436.
[17] Badagliacca R,Poscia R,Pezzuto B,et al.Prognostic relevance of right heart reverse remodeling in idiopathic pulmonary arterial hypertension[J].J Heart Lung Transplant,2017,S1053-2498(17)32041-7.
[18] Tello K,Wan J,Dalmer A,et al.Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension[J].Circ Cardiovasc Imaging,2019,12(9):e009047.
[19] Raitière O,Berthelot E,Fauvel C,et al.The dangerous and contradictory prognostic significance of PVR<3WU when TAPSE<16 mm in postcapillary pulmonary hypertension[J]. ESC Heart Fail,2020,7(5):2398-2405.
[20] 韩冰,方汝亮.缺血性心肌病相关肺动脉高压患者的临床特点分析[J].医学综述,2020,26(2):413-417.
-
计量
- 文章访问数: 597
- PDF下载数: 401
- 施引文献: 0
下载: