心脏瓣膜疾病与肺高压相关性的临床分析

Correlation of heart valvular diseases with pulmonary hypertension：a clinical analysis

摘要:

目的 分析心脏瓣膜疾病（HVD）与肺性高血压（PH）患者的临床资料，探讨两者的相关特征及导致PH发生的危险因素。方法 回顾性地分析2010年4月至2011年10月在南京医科大学第一附属医院心胸外科住院拟进行手术的256例具有完整临床资料的HVD患者资料，通过病史、体征结合二维心脏超声评估患者基本临床特征如肺动脉压等，并根据肺动脉压水平分为非PH组（n＝157，肺动脉压＜35mmHg；1mmHg＝0.133kPa）、疑诊PH组（n＝50，肺动脉压35～50mmHg）和PH组（n＝49，肺动脉压＞50mmHg）。采用多元回归分析等统计学方法比较并发PH与未并发PH患者的临床资料。结果 256例HVD患者中符合2009年欧洲心脏病学协会PH诊断标准的共49例。HVD并发PH组年龄为（50.2±8.7）岁，男女比为18∶31。其中，纽约心脏联合会（NYHA）分级（OR＝1.243）、左房内径（OR＝1.016）、心力衰竭病程（OR＝1.018）是HVD患者并发PH的危险因素。结论 HVD是引起PH的重要原因，PH患者体质量指数、NYHA分级、心房颤动、心力衰竭时间及左房内径与非PH患者差异有统计学意义，其中心功能（NYHA分级）差、左房内径大、心力衰竭病程长是并发PH的危险因素。

Abstract:

Objective To investigate the relative features of heart valvular diseases (HVD) and pulmonary hypertension (PH), and the risk factors of PH by analyzing the clinical data of these patients. Methods A total of 256 HVD patients with complete clinical data receiving surgical treatment in our hospital from April 2010 to October 2011 were subjected in the study. A retrospective analysis was carried out on case history, signs and symptoms, results of echocardiography and others on. The patients were divided into non-PH group (n＝157, pulmonary pressure＜35mmHg; 1mmHg＝0.133kPa), suspected PH group (n＝50, pulmonary pressure 35 to 50mmHg) and PH group (n＝49, pulmonary pressure＞50mmHg). Different statistical methods including multiple regressive analysis were used between these HVD patients with PH and without PH. Results In all of the 256 HVD patients, 49 patients were diagnosed with PH according to the diagnostic criteria of the European Society of Cardiology 2009. The HVD patients complicated with PH had an average age of 50.2 years, in a ratio of male to female of 18∶31. The Heart function grade of New York Heart Association (NYHA; OR＝1.243), left atrial diameter (LAD; OR＝1.016) and the duration of heart failure (OR＝1.018) were the risk factors of PH in HVD patients. Conclusion HVD is an important cause of PH. Significant differences are seen between PH patients and non-PH patients in body mass index, NYHA grade, LAD, duration of heart failure and atrial fibrillation. The lower heart function grade of NYHA, the larger LAD, and the longer duration of heart failure are risk factors for PH.