超声心动图测定三尖瓣反流估测的肺动脉收缩压的影响因素探讨

摘要

Objective To explore which factors influence pulmonary artery systolic pressure(PASP) calculated by echocardigraph through tricuspid regurgitation pressure gradient(TRPG).Methods The retrospective study recruited 869 consecutive inpatients.Their admission NYHA classification, N-terminal pro-B-type natriuretic peptide(NT-proBNP), echocardiographic and other clinic data were collected.PASP was derived from TRPG by echocardigraph.We analysed the correlations between PASP and age, sex, renal function, cardiopulmonary diseases and echocardigraph parameters, using single factor analysis and multivariate linear regression analysis.Results Among these patients, 658 were found to have TR, with a proportion of 75.7％.PASP was independently correlated to chronic obstructive pulmonary disease (COPD), chronic pulmonary embolism, left ventricular valve diseases and hypertension.PASP had independent correlation with both NYHA classification and NT-proBNP.PASP was correlated to TR severity positively, but not parallel to it.Age was an important predictor of PASP, with an average increase in PASP of 0.81 mm Hg per decade.Conclusions Tricuspid regurgitation is common in cardiac patients.PASP is independently correlated to COPD, chronic pulmonary embolism, left ventricular valve diseases and hypertension.PASP may rise with the increase of NYHA classification and NT-proBNP.It may play an important role in the evaluation of heart function.PASP should not be substituted by TR severity on the valuation of pulmonary circulation pressure.Age is an important predictor of PASP.%目的 探讨由超声心动图测定三尖瓣反流压力阶差估测肺动脉收缩压(PASP)的影响因素.方法 通过回顾性总结,连续入选2009年1月至8月在本医院心内科住院的患者869例,收集其一般临床资料、纽约心功能分级、氨基末端脑钠肽前体(NT-proBNP)及超声心动图报告指标,其中PASP由三尖瓣瓣反流压力阶差估测,对其相关因素进行单因素相关性分析及多元逐步回归分析.结果 检测出三尖瓣反流并估测PASP的患者658例,达75.7%;PASP与慢性阻塞性肺病(COPD)、慢性肺栓塞、主动脉瓣狭窄、主动脉瓣反流、二尖瓣反流,高血压病独立正相关;NYHA分级、1gNT-proBNP亦是PASP独立相关因素;PASP 与三尖瓣反流严重程度独立正相关,但二者不完全平行变化;年龄每增加10岁,PASP平均升高0.81 mm Hg[1 mm Hg=0.133 kPa;B(SE):0.081(0.027),95%CI(0.028～0.134),P=0.002].结论 三尖瓣反流在心脏疾病患者中普遍存在,PASP与COPD、慢性肺栓塞、左心瓣膜病、高血压病独立正相关;PASP 随NYHA分级、1gNT-proBNP的升高而升高,提示其可用于评价心功能;在体现肺循环压力方面,PASP不能用三尖瓣反流严重程度来替代;年龄是PASP的重要影响因素.