继发孔型房间隔缺损患者肺动脉高压的相关危险因素

摘要

目的 初步探讨房间隔缺损患者肺动脉高压的相关危险因素.方法 收集182例继发孔型房间隔缺损患者资料,心脏彩色多普勒超声测量房间隔缺损大小、二尖瓣反流量、三尖瓣反流量、肺动脉收缩压,以及右心室、右心房、左心房有无扩大.按照肺动脉收缩压(PASP)的高低分为四组,无高压组(Ⅰ组,＜40mmHg),轻度高压组(Ⅱ组,40～49mmHg),中度高压组(Ⅲ组,50～59mmHg),重度高压组(Ⅳ组,＞60mmHg),分别与患者年龄、性别、缺损面积大小、二尖瓣反流量、三尖瓣反流度、肺部疾病、高血压、糖尿病等作统计学分析,探讨影响PASP的主要因素.结果 房间隔缺损患者随年龄的增大,PASP呈上升趋势,二者之间有显著相关性(r=0.303,P＜0.01);随房间隔缺损直径增大,PASP上升,二者之间有显著相关性(r=0.487,P＜0.01);中/重度三尖瓣反流量各组间差异明显;PASP的上升,致患者心功能恶化,NYHA III-IV级患者数量明显增加,二者之间具有显著相关性(r=0.255,P=0.001);Logistic回归分析显示,与中重度肺动脉高压(PAH)相关的单变量和多变量危险因素是年龄(OR 1.072,95%CI 1.039～1.105,P＜0.01)、房间隔缺损直径大小(OR 1.145,95%CI 1.091～1.201,P＜0.01)及中/重度三尖瓣反流(OR 4.612,95%CI 2.268～9.381,P＜0.01).结论 与房间隔缺损患者肺动脉高压的相关危险因素是年龄、缺损直径大小、中/重度三尖瓣反流.%Objective Identify the relevant risk factors of to patients with ostium secundum defect preliminarily. Methods Data of 182 patients with ostium secundum defect were collected. We measure and analyzed PASP, tricuspid regurgitation, mitral regurgitation, the diameter of ASD, righ atrium, right ventricle left atrium. They were categorized according the level of PASP into 4 groups; non pressure (GROUP I, <40mmHg) , mild pressure (GROUP II, 40 -49mmHg) , moderate pressure (GROUP III, 50 -59mmHg) , severe pressure (GROUP IV, > 60mmH) ;Make a statistic analysis between PASP and factors such as age, gender, body surface area, defect size, mitral regurgitation, tricuspid regurgitation, pulmonary disease, blood pressure, diabetes. Then find out the most notable factor. Results For ASD patients, their PASP displayed a tendency of elevation with the age. There was a significant correlation between them(r =0. 303 ,P <0. 01). Their PASP rose up considerably as the diameter of ASD ( Atrial Septal Defect) increases. They displayed a significant correlation(r = 0. 487 ,P < 0. 01). Moderate and severe tricuspid regurgitation also showed a significant difference in every group. The constant rise of PASP resulted in the deterioration of patients' NYHA as the number of patients with NYHA III - IV increased considerably. There was a significant correlation between them ( r = 0. 255, P = 0. 001). Conclusions The univariate and multivariate hazards related to the moderate and severe PAH are age(OR 1. 072,95% CI: 1.039-1. 105 ;P<0.01), ASD diameter (OR 1. 145,95% CI 1. 091 - 1. 201; (P <0. 01) ,and moderate and severe tricuspid regurgitation( OR 4. 612,95% CI 2. 268 - 9. 381 -P <0. 01).