慢性阻塞性肺疾病患者右心功能的评估

Evaluation of right heart function in patients with chronic obstructive pulmonary disease

目的应用超声心动图评价慢性阻塞性肺疾病(COPD)患者右心功能,探讨不同肺功能损坏程度的COPD患者右心结构和功能的变化。方法将85例COPD患者行肺功能测定后根据疾病严重程度分为3组:轻度组36例,中度组33例,重度组16例。同时选取60名健康成人为对照组。所有受试者行超声心动图检查,比较4组之间的右心房、室大小指标、右心室舒张及收缩功能指标、肺动脉压指标的差异。结果 COPD轻度组患者仅有右心室基底径、三尖瓣反流(TR)最大压差及肺动脉收缩压(PASP)大于对照组[(3.28±0.71)cm比(3.20±0.79)cm,(22.22±1.76)mmHg比(18.31±2.17)mmHg,(35.63±2.25)mmHg比(23.83±2.56)mmHg,均为P<0.01]。与对照组、COPD轻度组和中度组比较,重度组的E/E'增大(7.79±1.73比5.04±1.78、5.37±1.19和5.64±1.81,均为P<0.01),右心室面积改变分数、三尖瓣环平面收缩移位降低[29.11%±8.41%比38.38%±9.45%、37.41%±8.49%和35.98%±10.59%;(18.08±4.62)cm比(22.37±4.09)cm、(21.09±2.46)cm和(20.71±4.82)cm,均为P<0.01]。COPD患者3组间右心室基底径、TR最大压差及PASP差异均有统计学意义[(3.28±0.71)cm比(4.58±0.57)cm比(4.92±0.80)cm;(22.22±1.76)mmHg比(31.00±8.51)mmHg比(49.00±7.45)mmHg;(35.63±2.25)mmHg比(40.17±2.97)mmHg比(59.00±2.54)mmHg,均为P<0.01],且随肺功能恶化而增大。结论 COPD患者随着肺功能的恶化,肺动脉压进行性升高,首先出现右心结构的改变,进而出现右心室心肌的舒张及收缩功能下降,且右心室舒张功能不全出现于明显收缩功能不全之前。

Objective To evaluate the right heart function in patients with chronic obstructive pulmonary disease（ COPD） by echocardiography,and to find out the correlation between echocardiographic findings and severity of COPD. Methods A total of 85 patients with COPD were selected and staged by pulmonary function test（ PFT）,of which 36 were mild,33 were moderate and 16 were severe. And 60 healthy volunteers were as controls. All the subjects were evaluated by echocardiography. Results Right ventricular（ RV） basal diameter,tricuspid regurgitation（ TR） maximum pressure and pulmonary artery systolic pressure（ PASP） were significantly greater in mild group than in control group [（ 3. 28 ± 0. 71） cm vs.（ 3. 20 ± 0. 79） cm,（ 22. 22 ± 1. 76） mmHg vs.（ 18. 31 ± 2. 17） mmHg,and（ 35. 63 ± 2. 25） mmHg vs.（ 23.83 ±2.56） mmHg,respectively,all P〈0.01]. Compared with other three groups,E/E＇ in severe group was significantly increased（ 7. 79 ± 1. 73 vs. 5. 04 ± 1. 78,5. 37 ± 1. 19 and 5. 64 ± 1. 81,respectively,all P〈0. 01）,right ventricular fractional area change（ FAC） and tricuspid annular plane systolic excursion（ TAPSE） significantly lower [29. 11% ± 8. 41% vs. 38. 38% ± 9. 45%,37. 41% ±8. 49% and 35. 98% ± 10. 59%;（ 18. 08 ± 4. 62） cm vs.（ 22. 37 ± 4. 09） cm,（ 21. 09 ± 2. 46） cm and（ 20.71 ±4.82） cm,respectively,all P〈0.01]. RV basal diameter,TR and PASP in the three COPD groups were significantly different [（ 3. 28 ± 0. 71） cm vs.（ 4. 58 ± 0. 57） cm vs.（ 4. 92 ± 0. 80） cm;（ 22. 22± 1. 76） mmHg vs.（ 31. 00 ± 8. 51） mmHg vs.（ 49. 00 ± 7. 45） mmHg;（ 35. 63 ± 2. 25） mmHg vs.（ 40. 17± 2. 97） mmHg vs.（ 59. 00 ± 2. 54） mmHg,all P〈0. 01],and increased with the severity of COPD.Conclusions With the deterioration of lung function in COPD patients,pulmonary artery pressure is increased. Structural changes appear firstly in right heart,and then right ventricular diastolic and systolic dysfunction appears. Right ventricular diastolic dysfunction appears earlier than significant systolic dysfunction.