P波离散度对肺动脉高压诊断和预后评估的临床应用价值

The dinical value of p-wave dispersion in the diagnosis and prognosis of pulmonary arterial hypertension

目的探讨P波离散度(PWD)对肺动脉高压(PAH)诊断及预后评估的临床应用价值。方法收集PAH患者103例、对照组30例,测量所有研究对象的PWD,并收集血生化指标、超声心动图及右心导管血流动力学参数等指标,分析PWD在各组中的变化以及与各指标的相关性;根据2018 WSPH会议推荐的风险评估表,将PAH患者病情严重程度分为低、中、高危3组,比较PWD在各组之间的差异。采用ROC曲线评价PWD对PAH发生的诊断效能。结果PAH组的PWD显著增大(P<0.001)。PWD与混合静脉血氧饱和度、心指数呈负相关(r值分别为-0.388、-0.331,P均<0.05),PWD与右心房平均压、NT-proBNP呈正相关(r值分别为0.321、0.636,P均<0.001)。PAH患者危险分层后显示PWD在低、中、高危三组有显著差异(43.89±9.91,51.29±6.61,62.15±10.44,P均<0.05),且PWD与PAH危险分层量化值呈正相关关系(r=0.592,P<0.001)。PWD>41.45 ms时,PWD预测PAH的灵敏度、特异度最高,分别为85.44%、86.67%。结论PWD与PAH诊断及预后相关的各指标密切相关,提示监测PWD对PAH患者的诊断及预后评估具有一定的临床指导意义。

Objective To explore the dinical value of p-wave dispersion(PWD)in thediagnosis and prognosis evduation of pulmonary arterial hypertension.Methods 103 cases of PAH patients and 30 healthy controls were collected.We measured the PWD of all personnel and collected indicators including blood biochemical indicators,echocardiography,and right-heart catheter hemodynamic parameters.So that we can analyze the change of PWD in each group and its correlation with various indicators.According to the risk assessment form recommended by the 2018 WSPH conference,the severity of PAH patients was divided into three groups:low,medium and high risk,therefore to compare the differences of PWD among the groups.We used ROC curve to evaluate the diagnostic efficacy of PWD on PAH.Results Significant increase in PWD in PAH group(P<0.001).PWD was significantly negatively correlated with mixed venous oxygen saturation and cardiac index(r values were-0.388,-0.331,P values are all<0.05).PWD was positively correlated with right atrial mean pressure and NT-proBNP(r values were 0.321,0.636,P values are all<0.001).After the risk stratification of PAH patients,it was indicated that the groups of low,medium and high risk in PWD showed significant differences(43.89±9.91,51.29±6.61,62.15±10.44,P values are all<0.05),meanwhile there was a positive correlation between PWD and the quantitative value of PAH risk stratification(r=0.592,P<0.001).When PWD>41.45 ms,PWD has the highest sensitivity and specificity for predicting PAH,which are 85.44%and 86.67%,respectively.Conclusions PWD is significantly increased in patients with PAH,and it has a bearing on various indicators related to the diagnosis and prognosis of PAH,suggesting that PWD has certain clinical guiding significance for the diagnosis and prognosis evaluation of PAH patients.