肺动脉高压患者的现状调查及病因构成

摘要

目的:调查成人肺动脉高压(pulmonary hypertension,PH)患者的人口学特征和不同病因之间的构成比.方法:回顾性调查2010年1月至2014年12月中南大学湘雅二医院经临床诊断或经胸多普勒超声、右心导管检查诊断为PH的2 508例成人住院患者,收集其临床资料,包括研究对象的性别、年龄、原发病等,并进行统计学分析.结果:本次调查中PH患者人数逐年上升,患者年龄为47(18～93)岁;男性933例(37.20％),男:女约为1:1.69(P＜0.05).其中,第Ⅰ类PH(动脉型PH)与第Ⅱ类PH(左心疾病相关的PH)以女性多见(＞70％),第Ⅲ类(呼吸系统疾病或缺氧相关性PH)以男性多见(74.5％).在本次调查中,第Ⅰ类PH 896例(35.73％)、第Ⅱ类PH 1163例(46.37％)、第Ⅲ类PH 411例(16.39％)、第Ⅳ类PH(慢性血栓性PH)32例(1.27％)、第Ⅴ类PH(原因不明或多种因素所致PH)6例(0.24％).发病例数居前7位的PH原发病依次为风湿性心脏病(1 090例,43.48％)、先天性心脏病(692例,27.60％)、慢性阻塞性肺疾病(358例,14.28％)、结缔组织相关性疾病(156例,6.22％)、瓣膜性心脏病(66例,2.63％)、特发性PH(46例,1.83％)、肺栓塞(27例,1.08％).结论:在本次调查中成人PH发病的高峰年龄阶段是41～50岁,其中以女性多见,且第Ⅰ类及第Ⅱ类PH以女性多见,第Ⅲ类PH以男性多见;风湿性心脏病及先天性心脏病是目前中国PH最常见的病因;慢性阻塞性肺疾病是第Ⅲ类PH最常见病因,且此类患者年龄较大.%Objective:To investigate the demographic characteristics and the causes for pulmonary hypertension (PH) in adult patients.Methods:A total of 2 508 adult patients diagnosed as PH,who came from the Second Xiangya Hospital of Central South University from January 2010 to December 2014,were retrospectively investigated.All subjects underwent the clinical diagnosis,or the echocardiographic diagnosis,or thetraditional hemodynamic criteria by right heart catheterization (RHC).The patient's data including hospital numbers,gender,ages,primary diseases,etc,are collected and analyzed.Results:In this study,the number of patients diagnosed as PH was increased year by year.The median age of 2 508 patients was 47 (18-93) years old,and there were 933 males (37.2％),the ratio of male to female was 1:1.69 (P＜0.05).Female was more common in Class Ⅰ PH (pulmonary arterial hypertension) and Class Ⅱ PH (pulmonary hypertension due to left heart disease)(＞70％),but there were more male patients (74.5％) in Class Ⅲ PH (pulmonary hypertension due to lung diseases and/or hypoxia).In our study,896 cases (35.73％) were the Class Ⅰ PH,1 163 cases was the Class Ⅱ PH (46.37％),411 cases was the Class Ⅲ PH (16.39％),and the Class Ⅳ PH (chronic thromboembolic pulmonary hypertension) and the Class Ⅴ PH (PH with unclear and/ or multifactorial mechanisms) were diagnosed in 32(1.27％) and 6 patients (0.24％),respectively.The diseases with largest number of patients for the top 7 primary PH were rheumatic heart disease (1 090,43.48％),congenital heart disease (692,27.60％),chronic obstructive pulmonary disease (358,14.28％),connective tissue related disease(156,6.22％),valvular heart disease (66,2.63％),idiopathic PH (46,1.83％) and pulmonary embolism (27,1.08％).Conclusion:Adult PH patients' peak incidence age is 41-50 years old.This disease is more common among women,and the Class Ⅰ/Ⅱ PH are common in women while the Class Ⅲ is more common in men.Rheumatic heart disease and congenital heart disease may be the most common cause for pulmonary hypertension in China,and chronic obstructive pulmonary disease is the most common cause for the Class Ⅲ PH,in which the patients are old.