单纯性舒张功能障碍高血压患者发生肺动脉高压的相关因素分析

Correlative factors of pulmonary hypertension of hypertensive patients with isolated diastolic heart failure

目的通过对单纯性舒张功能障碍的高血压患者进行肺动脉高压流行性研究，分析单纯性舒张功能障碍的高血压患者发生肺动脉高压相关因素。方法连续入选经超声心动图检查证实为单纯性舒张功能障碍的高血压患者800例，根据是否伴有肺动脉高压分为观察组（舒张功能障碍＋肺动脉高压，161例）和对照组（舒张功能障碍，639例）。所有患者使用经胸超声多普勒测量肺动脉收缩压、左心房和左心室内径及质量指数，左心室舒张功能检测指标包括二尖瓣口及二尖瓣环、肺静脉血流频谱检测结果。结果观察组较对照组的年龄偏大，合并心房颤动偏多，组问差异均有统计学意义[年龄：（76±8）岁比（63±6）岁，心房颤动：26．7％（43／161）比5．8％（37／639），均P〈0．01]。观察组较对照组左心房内径更大、二尖瓣环舒张早期峰值流速更低，组间差异有统计学意义[左心房内径：（49±8）mm比（38±7）mm，二尖瓣环舒张早期峰值流速：（4．9±1．0）cm／s比（6．7±1．1）cm／s，均P〈0．01]。多因素回归分析显示年龄、心房颤动、二尖瓣环舒张早期峰值流速的相对危险度Exp（β）分别为1．168（95％CI：1．025-1．246）、2．235（95％CI：1．125-4．438）和0．386（95％CI：0．196-0．846），差异均有统计学意义（均P〈0．05）。结论在单纯性舒张功能障碍的高血压患者肺动脉高压发生率较高，年龄、心房颤动、二尖瓣环舒张早期峰值流速是肺动脉高压的独立预测因素。

Objective To explore the prevalence of pulmonary hypertension in hypertensive patients with i- solated diastolic heart failure, and to analyze the related clinical features. Methods We enrolled 800 consecutive hypertensive patients with isolated diastolic heart failure. All patients underwent transthoracic doppler echocardio- graphy to measure the pulmonary artery systolic pressure, left atrial diameter and left ventrieular mass index, dias- tolic function indices （including transmitral and mitral annular flow, pulmonary venous flow）. We divided patients into two groups： one with diastolic heart failure and concomitant pulmonary hypertension, and one with diastolic heart failure but without concomitant pulmonary hypertension. Results Compared with control group of diastolic heart failure without concomitant pulmonary hypertension, patients with pulmonary hypertension were older [ （76 ± 8 ） years old vs （ 63 ± 6） years old, P 〈 0.01 ], more likely to have atrial fibrillation [ 26. 7% （43/161） vs 5.8% （ 37/639 ）, P 〈 0.01 ], larger left atrial diameter [ （49 ± 8 ） mm vs （ 38 ± 7 ） mm, P 〈 0. 01 ] and lower early mitral annular diastolic velocity [ （4.9 ± 1.0） em/s vs （ 6.7 ± 1.1 ） cm/s, P 〈 0. 01 ]. Multivariate logistic regression a- nalysis identified age, atrial fibrillation, early mitral annular diastolic velocity as the independent predictors of the presence of pulmonary hypertension. Conclusions Pulmonary hypertension is prevalent in hypertensive patients with diastolic heart failure. Age, atrial fibrillation, early mitral annular diastolic velocity are the independent predic- tors of the presence of pulmonary hypertension in this patient group.