晚期扩张型心肌病并肺动脉高压临床、右心导管参数特点及相关危险因素分析

摘要

目的：研究晚期扩张型心肌病并肺动脉高压患者临床及右心导管参数的特点。方法晚期扩张型心肌病患者39例,根据床旁右心导管所测平均肺动脉压(mPAP)是否大于等于25 mmHg(1 mmHg=0.133 kPa)分为扩张型心肌病并肺动脉高压组(DCM+PH,n =23)及单纯扩张型心肌病组(DCM,n =16),对比两组临床及右心导管参数的特点。结果与 DCM 组比较,DCM+PH 组患者病程长(6.68±5.57)年 vs (3.32±3.37)年(P <0.05),氨基末端脑纳肽(NT-proBNP)水平升高(4232.89±1430.56)ng/L vs (1794.80±1067.95)ng/L(P <0.05),左心室扩大(72.68±11.52)mm vs (65.94±6.81)mm(P <0.05),mPAP 增高(39.81±12.90)mmHg vs (17.19±13.61)mmHg(P <0.05),肺动脉楔压(PCWP)增高(25.00±5.93)mmHg vs (11.25±6.77)mmHg(P <0.05),心输出量(CO)降低(3.46±1.25)L/min vs (4.65±1.28)L/min(P <0.05),肺血管阻力(PVR)增高(32.872±23.069)kPa·s·L-1 vs (17.871±8.908)kPa·s·L-1(P <0.05),多因素回归分析显示,病程和 NT-proBNP 水平是扩张型心肌病并肺动脉高压的独立危险因素。结论晚期扩张型心肌病并肺动脉高压患者 mPAP 为轻中度升高,有较长的病程,NT-proBNP、PCWP、PVR 均升高,CO 降低。病程和 NT-proBNP 水平是扩张型心肌病并肺动脉高压的独立危险因素。%Objective To explore the clinical characteristics and right heart catheter parameters in end-stage dilated cardiomyopathy(DCM)patients with pulmonary hypertension(PH).Methods A total of 39 patients with end-stage DCM were enrolled in this study.In terms of mean pulmonary artery pressure (mPAP)measured by right heart catheter,the DCM patients were divided into normal pulmonary hypertension group (DCM,mPAP<25 mmHg,n =1 6)and pulmonary hypertension group(DCM+PH,mPAP≥25 mmHg,n =23).Results Compared with the DCM patients,DCM+PH patients showed significant differences in disease duration (6.68 ±5.57)years vs (3.32 ±3.37) years(P <0.05),circulating NT-proBNP level (4 232.89 ± 1 430.56 )ng/L vs (1 794.80 ± 1 067.95 )ng/L(P <0.05),left ventricular size (72.68±1 1.52)mm vs (65.94±6.81)mm(P <0.05),mPAP (25.00±5.93)mmHg vs (1 1.25±6.77)mmHg(P <0.05),PCWP(25.00±5.93)mmHg vs (1 1.25±6.77)mmHg(P <0.01),CO(3.46± 1.25)L/min vs (4.65±1.28)L/min(P <0.05 ),and PVR (32.872 ± 23.069 )kPa· s· L-1 vs (1 7.871 ± 8.908) kPa·s·L-1 (P <0.05).Multivariate logistic regression analysis revealed that disease duration and circulating NT-proBNP level were considered as the independent risks of DCM patients with PH.Conclusion The end-stage DCM patients with PH had a longer disease duration,larger left ventricle,higher circulating NT-proBNP level,higher mPAP,higher PCWP,higher PVR and lower CO.Disease duration and circulating NT-proBNP level were considered as the independent risks of DCM patients with PH.