超声心动图对肺动脉高压和肺静脉高压的非侵入性鉴别诊断研究

摘要

目的 确定超声心动图是否能非侵入性鉴别诊断肺动脉高压(PAH)和肺静脉高压(PVH).方法 随机选择56例经超声心动图确定的肺动脉收缩压(PASP)≥40 mmHg的患者,并在7 d内进行心导管检查.依据左室舒张末压或肺毛细血管契压(PCWP)将患者分为PAH组30例,PVH组26例.两组患者应用常规和组织多普勒超声技术分别测定跨二尖瓣舒张早期峰值血流速度E峰,晚期A峰,E/A比值,二尖瓣血流减速时间(DT),舒张早期二尖瓣环运动速度(E')和E/E'值.结果 与PVH组比较,PAH组A峰、DT、PASP及E,增大,而E峰、E/A值和E/E'值却降低.E/E'值和E/A值是PAH和PVH鉴别诊断的最佳指标,其E/E'值和E/A值的ROC曲线下面积分别为97%和91%,而诊断PVH的最佳界值点是E/E'>9.2(敏感性为95%,特异性为97%),E/A>1.7(敏感性为75%,特异性为92%).结论 采用常规和组织多普勒超声技术可正确鉴别PAH和PVH.%Objective To determine whether pulmonary arterial hypertension(PAH) and pulmonary venous hypertension (PVH) can be differentiated noninvasively by echocardiography. Methods Fifty-six patients with pulmonary arterial systolic pressure(PASP) ≥40 mmHg by echocardiography were involved,and cardiac catheterization performed within 7 days of each other. Based on left ventricular end-diastolic pressure or pulmonary capillary wedge pressure(PCWP) ,30 patients were classified as PAH group and 26 patients as PVH group. The early(E) and late(A) diastolic mitral inflow velocities,E/A ratios,deceleration time(DT),early dastlic mitrial annular velocity(E') and E/E' ratios were measured by conventional and Doppler tissue imaging echocardiography in the two groups. Results Compared with PVH group,the PAH group had significantly higher A,DT,PASP and E',and significantly lower E,E/A ratio and E/E' ratio (P < 0. 01 or P <0. 001). E/E' and E/A ratio was optimal indexes for differentiation of PAH and PVH,the area under receiver operating characteristic curve was 97% and 91 %, respectively. Optimal cutoff for diagnosing PVH was E/E'>9.2 (sensitivity 95%, specificity 97%) and E/A> 1. 7 (sensitivity 75%,specificity 92%). Conclusions PAH and PVH imaging can be reliably differentiated by echocardiography.