经胸超声心动图在特发性肺动脉高压诊断中的临床价值

Echocardiography for the diagnosis of idiopathic pulmonary arterial hypertension

目的探讨经胸超声心动图在特发性肺动脉高压诊断中的临床价值。方法选取山东省菏泽市牡丹人民医院2010年12月～2012年11月收治的特发性肺动脉高压59例作为观察组,行经胸超声心动图检查和心导管检查。选取本院同期健康体检人员60例为对照组,行经胸超声心动图检查。比较两组人员经胸超声心动图检查结果,观察两组经胸超声心动图检查结果和心导管检查结果,分析经胸超声心动图检查与心导管检查的相关性。采用SPSS 16.0软件进行统计学分析。结果观察组肺动脉压[(89.4±26.5)mm Hg,1 mm Hg=0.133 kPa]明显高于对照组[(29.3±10.4)mm Hg],观察组肺动脉内径[(28.1±4.3)mm]明显小于对照组[(32.7±4.2)mm],观察组右房横径[(56.7±5.2)mm]、右房纵径[(63.5±7.4)mm]均明显大于对照组[(42.0±3.8)mm、(53.6±5.1)mm],差异均有统计学意义(均P<0.05)。观察组患者均表现为不同程度的右房增大和肺动脉增厚,同时出现了不同程度的三尖瓣反流。观察组心导管检查结果中肺动脉压[(84.6±25.7)mm Hg]低于经胸超声心动图检查结果[(89.4±26.5)mm Hg],差异无统计学意义(P>0.05)。经胸超声心动图检查与心导管检查具有一定的正相关性(r=0.719,P=0.003)。经胸超声心动图检查结果中,56例可确诊为特发性肺动脉高压,3例误诊,临床诊断符合率为94.9%,误诊患者后经心导管检查确诊。观察组左室收缩功能减弱患者的肺动脉压[(90.8±24.6)mm Hg]明显高于左室收缩功能正常患者[(65.7±19.0)mm Hg],差异有统计学意义(P<0.05)。结论经胸超声心动图是一种安全无创的检测手段,准确性高且重复性好,在特发性肺动脉高压诊断中具有重要的临床价值,值得临床推广使用。

Objective To explore the clinical value of echocardiography for the diagnosis of idiopathic pulmonary arterial hypertension. Methods 59 patients with idiopathic pulmonary arterial hypertension were received in Mudan People＇s Hospital of Heze City in Shandong Province from December 2010 to November 2012 as observation group. Echocardiography and cardiac catheter detection were used. 60 health physical examination cases were as the control group at the same time. Echocardiography was applied only in the later. The results of echocardiography between two groups and the results of echocardiography and cardiac catheter of observation group were compared and analyzed, in order to find the correlations between the two detection methods. SPSS 16.0 software was used for statistical analysis. Results The pulmonary artery pressure （PAP） （89.4±26.5）mm Hg （1 mm Hg = 0.133 kPa） of observation group was re- markably higher than that （29.3±10.4）mm Hg of control group. The pulmonary artery diameter （28.1±4.3） mm was sig- nificantly less than that （32.7±4.2）mm of control group. The RATD and RALD were obviously more than that of control group. It had the statistical difference （all P 〈 0.05）. The patients of observation group showed inordinate dilated left atrium and pulmonary artery thickening with tricuspid regurgitation occurring simultaneously. The PAP （84.6±25.7）mm Hg of using cardiac catheter in observation was lower than it （89.4±26.5）mm Hg with echocardiography. It had no significance （P 〉 0.05）. Echocardiography had the correlation with cardiac catheter detection （r = 0.719,P = 0.003）. 56 cases were diagnozed to be idiopathic pulmonary arterial hypertension with echocardiography, only 3 ones were misdiagnosed among them. The clinical diagnose accordance rate was 94.9%. The misdiagnosed was confirmed after cardiac catheter detection. The PAP （90.8±24.6）mm Hg of patients with depression of left ventricle contraction in observation group was remarkably higher than （65.7±19.0）mm Hg of normal left ventricle contraction （P 〈 0.05）. Conclusion Echocardiography is a safe, noninvasive method. It has higher accurac, y and repeatability and has important clinical value in diagnosis of idiopathic pulmonary arterial hypertension. It is worthy of promotion in clinic.