肺动脉收缩压与左心室舒张功能不全的相关性及对预后的指导意义

摘要

Objective To explore the correlation between pulmonary artery systolic pressure(PASP)and left ventricular diastolic dys-function (LVDD)and its guiding value of prognosis.Methods One hundred and sixty patients with diastolic heart failure admitted in the hospital from January 2013 to December 2015 and 100 healthy individuals undergoing physical examinations during the same pe-riod were selected as research subjects.One hundred and sixty patients with diastolic heart failure were divided into group A and group B according to the existence of pulmonary artery hypertension.Ninety eight patients in group A were not accompanied with pulmonary artery hypertension,and 62 patients were accompanied with pulmonary artery hypertension.One hundred healthy individu-als were as controls.Doppler echocardiography and echocardiography indexes of three groups were compared.Results Interventric-ular septum depth (IVSd),left ventricular posterior wal depth (LVPWd),left atrial diastolic diameter (LADs),left ventricular end dias-tolic dimension (LVDd),N terminal pro B type natriuretic peptide (NT proBNP)in group A and group B were higher than that in control group (P>0.05).There was no difference in IVSd,LVPWd,LADs,LVDd between two groups (P>0.05).NT proBNP was higher in group B than that in group A(P<0.05).E/A value in group B was higher than that in control group.The peak value in group A was lower than that in the control group (P<0.05).EDT in group A was higher than that in control group (P< 0.05).There was no difference in EDT between group B and control group (P>0.05).E′peak value and E/E′value in group A and group B was lower and higher than that in control group.E′peak in group B was lower than that in group A,E/E′value of patients in group B was higher than that in Group A(P<0.05).The correlation between PASPand E/E′value among three group was slight (r=0.481,P<0.01). There was no correlation between PASA with E/E′value of patients in group A (r=0.329,P>0.05).There was correlation between PASA and E/E′value of patient in group B (r= 0.878,P<0.001).Conclusion The fil ing degree of left ventricular of patients with LVDD concurrently with artery pulmonary hypertension may reflect the hypertension degree of pulmonary artery.PASP is possibly to become a new indicator to determine the prognosis and treatment of diastolic heart failure.%目的：探讨肺动脉收缩压左心室舒张功能不全相关性,及其对预后、治疗的指导价值。方法选取2013年1月—2015年12月治疗的160例舒张性心力衰竭病人及同期于我院行健康体检100名健康人为研究对象。根据是否合并肺动脉高压,将160例舒张性心力衰竭病人分为 A、B两组,A组98例未合并肺动脉高压,B组62例合并有肺动脉高压,100名健康人作为对照组,对3组研究对象行多普勒超声心动图检查,并比较各项超声心动图检查指标。结果 A、B两组舒张末期室间隔厚度(IVSd)、舒张末期左室后壁厚度(LVPWd)、左房舒张末期内径(LADs)、左室舒张末期内径(LVDd)、N末端脑钠肽原(NT proBNP)均高于对照组,差异有统计学意义(P<0.05),但 A、B两组 IVSd、LVPWd、LADs、LVDd比较,差异无统计学意义(P>0.05),B组 NT proBNP高于 A组,差异有统计学意义(P<0.05)；二尖瓣舒张早期与舒张晚期的血流速度峰值(E)/舒张晚期的血流速度峰值(A)值高于对照组,而A峰值低于对照组,差异有统计学意义(P<0.05)；A组 E峰减速时间(EDT)长于对照组,差异有统计学意义(P<0.05)；B组 EDT与对照组比较,差异无统计学意义(P>0.05)；A、B两组 E′峰值低于对照组,E/E′值高于对照组,且 B组 E′峰值低于 A组,E/E′值大于 A组,差异有统计学意义(P<0.05)；3组肺动脉收缩压(PASP)与 E/E′值存在相关性(r=0.481,P<0.01)；A组 PASA与 E/E′值无相关性(r=0.329,P>0.05)；B组 PASA与 E/E′值相关性较强(r=0.878,P<0.001)。结论左心室舒张功能不全合并肺动脉高压病人的左心室充盈程度可反映出肺动脉高压程度；PASP可能为一项判断舒张性心力衰竭预后的新指标。