右室游离壁纵向应变预测肺动脉高压不良预后的临床研究

发布时间：2018-04-05 14:21

  本文选题：斑点追踪技术　切入点：肺动脉高压　出处：《中国超声医学杂志》2017年10期

【摘要】：目的应用超声二维斑点追踪技术测量肺动脉高压(PH)患者右室游离壁纵向应变(RVLS_(FW)),探讨该参数在评估PH患者不良预后方面的临床应用价值。方法临床经右心导管确诊、资料完整PH患者50例。临床资料参数包括:WHO功能分级(WHO FC)、6min步行距离(6MWD)及N端脑利钠肽前体(NT-proBNP)。超声心动图检测参数包括:右室游离壁纵向应变(RVLS_(FW))、三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(FAC)、三尖瓣环收缩期峰值速度(s′)及右心做功指数(RIMP);三尖瓣反流压差法估测肺动脉收缩压(sPAP)。右心导管参数包括:肺动脉平均压(mPAP)、肺毛细血管阻力(PVR)、肺毛细血管楔压(PCWP)及心指数(CI)。结果 (1)RVLS_(FW)与CI呈负相关关系(r=-0.692,P0.001),与PVR呈正相关关系(r=0.684,P0.001)。(2)以死亡、肺动脉血栓内膜剥脱术、急性心力衰竭再入院作为不良预后事件,随访时间(15.2±10.5)个月,有26例患者出现不良事件。多因素COX回归分析NT-proBNP(HR=1.000,P=0.028)及RVLS_(FW)(HR=2.084,P=0.046)与不良预后事件密切相关。(3)以RVLS_(FW)值中位数-16%为界值将患者分为2组:组Ⅰ(RVLS_(FW)值-16%),组Ⅱ(RVLS_(FW)值-16%)。组Ⅱ患者较组Ⅰ患者sPAP升高,RVLS_(FW)减低(P0.01)。2组患者mPAP、PVR、PCWP及CI之间差异有统计学意义(P0.01);组Ⅱ患者mPAP、PCWP及PVR明显升高,CI较组Ⅰ患者明显减低。组Ⅱ患者发生不良事件及死亡风险升高,远期预后不佳(χ~2=12.299,P0.001)。结论右室游离壁纵向应变能够反映PH患者右心功能减低程度,有助于预测患者不良预后,为临床综合管理PH患者提供有价值的参考指标。
[Abstract]:Objective to measure the longitudinal strain of right ventricular free wall in patients with pulmonary hypertension (PHH) by using two dimensional ultrasonic speckle tracing technique and to explore the clinical value of this parameter in evaluating the poor prognosis of patients with PH.Methods 50 patients with PH were diagnosed by right cardiac catheterization.The clinical data included 6 MWDs (6 minutes walking distance) and NT-proBNPP, a precursor of N-terminal brain natriuretic peptide (NT-proBNPP).Method to estimate pulmonary arterial systolic pressure (PAP).The parameters of right cardiac catheterization included mean pulmonary artery pressure (MPAP), pulmonary capillary resistance (PVR), pulmonary capillary wedge pressure (PCWP) and cardiac index (CI).The adverse events and the risk of death were increased in group 鈪，

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