Study of ventricular end-diastolic diameter ratio in Han, Tibetan and Hui adults patients with congenital heart disease associated with pulmonary hypertension at high altitude area
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摘要: 目的 探索心室舒张末期直径比(VEDdR)在高海拔汉族、藏族、回族成人先天性心脏病相关肺动脉高压(CHD-PAH)患者病情评估中的价值及其在各民族间的差异。方法 将长期(≥10年)居住于2400 m以上的高海拔地区且在2014年1月—2021年7月经超声心动图或右心导管检查明确诊断为CHD的131例患者作为研究对象，根据是否合并PAH分为CHD组和CHD-PAH组。结果 ① CHD-PAH组窦性心动过缓、右束支传导阻滞、房室传导阻滞发生率高于CHD组，窦性心动过速低于CHD组；②与同民族CHD组比较，汉族CHD-PAH组VEDdR、红细胞分布宽度(RDW)均偏大，藏族CHD-PAH组VEDdR、RDW、中性粒细胞/淋巴细胞计数比值(NLR)均偏大，回族CHD-PAH组RDW偏大(P< 0.05)；③汉族、藏族、回族CHD组间VEDdR、NLR有显著差异，回族、汉族VEDdR大于藏族，回族NLR小于汉族(P< 0.05)；④汉族、藏族、回族CHD-PAH组间单核细胞计数/高密度脂蛋白胆固醇比值(MHR)有显著差异，藏族MHR高于汉族和回族(P< 0.05)；⑤VEDdR、RDW、NLR是CHD-PAH的独立危险因素；结论 高海拔地区合并PAH的成人CHD患者各种心律失常的发生率高于单纯CHD患者，VEDdR、RDW、NLR是CHD-PAH独立危险因素，VEDdR、RDW可作为初步判断患者病情严重程度的简易指标。Abstract: Objective To explore the value of Ventricular end-diastolic diameter ratio(VEDdR) in the evaluation of congenital heart disease associated with pulmonary hypertension(CHD-PAH) in Tibetan, Han and Hui patients at high altitude area and whether there were differences among different ethnic groups.Methods A total of 131 patients living in high altitude area above 2400 m for a long time(≥10 years) and diagnosed as congenital heart disease(CHD) by echocardiography or right heart catheterization from January 2014 to July 2021 were divided into CHD group and CHD-PAH group according to whether they were complicated with PAH.Results ① The incidence of sinus bradycardia, right bundle branch block and atrioventricular block in CHD-PAH patients werehigher than that of CHD patients, while sinus tachycardia lower. ②Compared with the same ethnic CHD patients, the Han CHD-PAH patients had higher VEDdR and red blood cell distribution width(RDW), Tibetan CHD-PAH patients had higher VEDdR、RDW and NLR, and Hui CHD-PAH patients had higher RDW. ③There were significant differences in VEDdR and NLR among Han, Tibetan and Hui. The VEDdR of Han and Hui was higher than that of Tibetan, the NLR of Hui CHD patients was lower that of Han. ④There were significant differences in MHR among CHD-PAH patients of Han, Tibetan and Hui. MHR of Tibetan was higher than that of Han and Hui. ⑤VEDdR, RDW and NLR were independent risk factors of CHD-PAH.Conclusion The incidence of various arrhythmias in adult patients with CHD-PAH in high altitude were higher than that in patients with CHD. VEDdR、RDW and NLR were independent risk factors for CHD-PAH. VEDdR and RDW can be used as simple indexes to preliminarily judge the severity of CHD-PAH.
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表 1 2组性别、年龄、民族的比较
Table 1. Comparison of gender, age and nation in two group
例(%), X±S 指标 CHD组 CHD-PAH组 χ2/F P 汉族(22例) 藏族(21例) 回族(16例) 汉族(33例) 藏族(26例) 回族(13例) 男性 9(40.91) 10(47.62) 8(50.00) 11(33.33) 12(46.15) 6(46.15) 1.958 0.855 年龄/岁 44.73±10.50 38.38±9.77 33.88±13.73 43.21±10.51 41.35±14.32 36.92±13.64 2.252 0.053 民族 22(37.29) 21(35.59) 16(27.12) 3 33(45.83) 26(36.11) 13(18.06) 1.770 0.413 
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表 2 2组心律失常的比较
Table 2. Comparison of arrhythmias in two group
例(%) 项目 CHD组(59例) CHD-PAH组(72例) χ2 P 正常心电图 38(64.41) 23(31.94) 13.734 < 0.01 心律失常 21(35.59) 49(68.06) 0.019* 窦性心动过速 10(47.62) 5(10.20) 窦性心动过缓 4(19.05) 13(26.53) 右束支传导阻滞 5(23.81) 22(44.90) 房室传导阻滞 1(4.76) 4(8.16) 其他 1(4.76) 5(10.20) *采用Fisher确切概率法
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表 3 2组临床资料的比较
Table 3. Comparison of clinical data in two group
M(P25, P75), X±S 指标 CHD组 CHD-PAH组 汉族(22例) 藏族(21例) 回族(16例) 汉族(33例) 藏族(26例) 回族(13例) RVEDd/mm 33.27±5.91 28.62±3.971) 32.19±2.831) 37.33±7.411) 36.62±7.372) 39.46±8.353) LVEDd/mm 45.86±5.06 46.05±5.51 41.75±2.521)2) 43.00 (38.50，47.50) 45.00 (39.75，57.25) 45.00 (43.50，47.50)3) VEDdR/mm 0.73±0.15 0.63±0.091) 0.77±0.082) 0.87±0.231) 0.76±0.282) 0.87±0.25 LVEF/% 67.05±4.56 65.62±3.26 65.00±3.46 64.42±7.24 65.00 (60.00，68.25) 60.00 (59.00，64.50)3) TV/(m·s-1) 2.34±0.55 2.40 (2.25，2.55)1) 2.03±0.281)2) 2.93±0.811) 3.30±0.742) 3.78±0.963)4) ΔP/mmHg 25.32±6.46 22.71±4.34 19.94±3.601) 40 (34.50，50.50)1) 44.81±9.822) 48.00 (36.50，57.50)3) RVOT/mm 28.96±5.07 30.00 (26.00，32.00) 30.13±3.90 33.18±7.161) 30.62±4.63 34.08±8.75 MPAD/mm 23.00±3.52 21.00±2.851) 20.94±2.171) 25.94±6.151) 26.32±6.822) 30.23±8.293 RDW/% 12.90 (12.38，13.90) 13.10±0.92 12.81±0.78 13.70 (12.65，18.60)1) 13.75 (12.65，16.08)2) 14.60 (13.10，15.80)3) NLR 1.79±0.78 1.43 (1.29，1.54) 1.63 (1.53，1.77)1) 2.03±0.94 2.04±0.892) 1.65 (1.38，3.13) MHR 0.38±0.17 0.43±0.19 0.41±0.13 0.33 (0.20，0.53) 0.55±0.254) 0.45 (0.39，0.65)5) 1 mmHg=0.133 kPa；与CHD组汉族比较，1)P < 0.05；与CHD组藏族比较，2)P < 0.05；与CHD组回族比较，3)P < 0.05；与CHD-PAH组汉族比较，4)P < 0.05；与CHD-PAH组藏族比较，5)P < 0.05。
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