Correlation between right ventricular function and quality of life in patients with pulmonary arterial hypertension
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摘要: 目的 探讨肺动脉高压(PAH)患者右心功能与健康相关生活质量(HRQoL)的相关关系。方法 纳入319例门诊PAH患者，采集人群一般临床资料、生化检测、血压、心率、超声心动图等数据。采用斑点追踪技术分析心脏超声图像，测量左右心应变。采用SF-36量表评估HRQoL。结果 在PAH患者中，合并右心功能障碍(RVD)的患者年龄更大、病程更长、氨基末端脑利钠肽前体(NT-proBNP)、平均肺动脉压(mPAP)更高，反映右心功能的指标三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(RVFAC)、三尖瓣S’和右室整体纵向应变(RVGLS)更低，同时生理健康总分和心理健康总分更低。逐步多元线性回归分析发现，患者PAH病程、NT-proBNP、TAPSE、RVGLS、BMI、mPAP及年龄与生理健康总分相关，PAH病程、TAPSE、RVGLS及LVGLS与心理健康总分相关。结论 发生RVD的PAH患者生活质量更差，PAH病程、TAPSE与RVGLS是影响患者生活质量的主要危险因素。Abstract: Objective To investigate the relationship between right ventricular function and health-related quality of life(HRQoL) in patients with pulmonary hypertension(PAH).Methods A total of 319 patients with PAH in the outpatient department were enrolled. The general clinical data, biochemical tests, blood pressure, heart rate, and echocardiography data were collected. Speckle tracking imaging was used to measure the strain of left and right heart, and HRQoL was evaluated by SF-36 scale.Results In patients with PAH, patients with right ventricular dysfunction(RVD) were older, had longer disease duration, higher NT-proBNP and mean pulmonary artery pressure(mPAP). Tricuspid annular plane systolic excursion(TAPSE), fractional area change of right ventricle(RVFAC), tricuspid S', and global longitudinal strain of the right ventricle(RVGLS), as well as total scores for physical and mental health were lower. Stepwise multiple linear regression analysis showed that the duration of disease, NT-proBNP, TAPSE, RVGLS, body mass index, mPAP, and age were related to total score for physical health, while the duration of disease, TAPSE, RVGLS, and LVGLS were related to total score for mental health.Conclusion The quality of life of PAH patients with RVD is worse. The course of disease, TAPSE, and RVGLS are the main risk factors affecting the quality of life.
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图 1 TAPSE、RVGLS与生理健康总分和心理健康总分相关性
Figure 1. Correlation between TAPSE, RVGLS, and total scores for physical and mental health
表 1 患者临床特征比较
Table 1. Clinical characteristics
例(%), X±S 指标 总体(319例) RVD(-)组(212例) RVD(+)组(107例) P 年龄/岁 59.0±12.0 57.2±11.6 62.6±11.9 <0.001 性别 197(61.8) 138(65.1) 59(55.1) 0.084 BMI/(kg/m2) 24.3±3.8 24.6±3.5 23.9±4.4 0.119 吸烟史 94(29.5) 61(28.8) 33(30.8) 0.702 饮酒史 104(32.6) 70(33.0) 34(31.8) 0.823 冠心病 79(24.8) 50(23.6) 29(27.1) 0.492 COPD 39(12.2) 25(11.8) 14(13.1) 0.740 糖尿病 131(41.1) 85(40.1) 46(43.0) 0.620 高血压 102(32.0) 62(29.2) 40(37.4) 0.141 PAH病程/年 5.3±2.8 4.3±2.6 7.5±1.9 <0.001 NT-proBNP/(ng/L) 461.8±721.7 230.9±444.3 919.3±922.8 <0.001 收缩压/mmHg 116.0±11.9 116.4±11.7 115.4±12.5 0.484 舒张压/mmHg 73.2±10.8 73.6±10.9 72.4±10.6 0.362 脉压差/mmHg 42.8±8.0 42.7±8.4 42.9±7.1 0.854 脉率/(次/min) 75.0±11.5 75.1±11.9 74.8±10.6 0.796 mPAP/mmHg 39.9±8.1 35.4±5.2 49.0±4.2 <0.001 LVEDV/mL 93.9±24.1 93.5±25.0 94.6±22.3 0.702 LVESV/mL 33.9±12.7 33.6±12.3 34.5±12.6 0.578 LVEF/% 64.2±9.8 64.4±9.6 63.8±10.1 0.634 TAPSE/mm 15.9±3.3 16.5±3.2 14.6±3.0 <0.001 三尖瓣S’/(cm/s) 14.0±2.8 14.1±2.8 10.8±2.6 <0.001 二尖瓣S’/(cm/s) 13.2±3.2 13.3±3.3 12.9±2.9 0.230 LVGCS/% 22.5±3.3 22.5±3.2 22.4±3.4 0.720 RVGLS/% 19.8±2.5 20.7±2.2 17.9±1.9 <0.001 LVGLS/% 21.1±2.3 21.3±2.3 20.8±2.3 0.093 COPD：慢性阻塞性肺疾病。 
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表 2 患者HRQoL评分比较
Table 2. HRQoL scores
X±S 指标 总体(319例) RVD(-)组(212例) RVD(+)组(107例) P 生理健康/分 生理机能 40.9±29.1 48.0±30.0 26.9±22.6 < 0.001 生理职能 45.7±33.5 59.7±31.1 18.0±16.6 < 0.001 躯体疼痛 60.8±25.2 62.7±22.8 57.2±29.1 0.068 一般健康状况 48.0±17.0 51.2±16.4 41.7±16.4 < 0.001 总分 48.9±17.8 55.4±16.4 35.9±12.8 < 0.001 心理健康/分 精力 45.5±20.0 50.3±18.8 36.1±19.0 < 0.001 社会功能 65.5±19.9 66.6±18.3 63.2±22.6 0.157 情感职能 69.1±28.7 72.7±25.1 62.1±33.8 0.002 精神健康 59.8±18.1 60.5±16.6 58.5±20.8 0.356 总分 60.0±13.8 62.5±12.5 55.0±14.8 < 0.001
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表 3 生理健康的危险因素
Table 3. Risk factors for physical health
变量 生理健康总分 β P PAH病程 -4.576 < 0.01 NT-proBNP -0.004 < 0.01 TAPSE 0.538 < 0.01 RVGLS 0.645 < 0.01 BMI -0.189 <0.05 mPAP -0.083 <0.05 年龄 -0.053 <0.05
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表 4 心理健康的危险因素
Table 4. Risk factors for physical health
变量 心理健康总分 β P PAH病程 -2.593 <0.01 TAPSE 1.263 <0.01 RVGLS 1.589 <0.01 LVGCS 0.408 <0.05
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