左心室射血分数保留的心力衰竭相关性肺高血压的临床特点及预后

The clinical characteristics and prognosis of pulmonary hypertension in hospitalized patients experiencing heart failure with preserved ejection fraction

目的分析住院治疗的左心室射血分数保留的心力衰竭（HFpEF）相关性肺高血压（PH-HFpEF）的临床特点及预后。方法入选2009年1月至2011年12月,住院诊断为HFpEF的患者200例,通过超声估测肺动脉收缩压（PASP）,分析PH-HFpEF的临床特点及对生存的影响。结果 HFpEF患者200例中,134例（67%）超声心动图（超声）检查可见三尖瓣反流,其中79例（58%）有肺高血压（PH）（≥40 mm Hg）。与HFpEF无PH组比较,HFpEF有PH组年龄,脉压更大、脑钠尿肽浓度更高（均P〈0.05）,两组用药情况差异无统计学意义。以性别、年龄、体质量指数（BMI）、心房颤动、脑钠尿肽为自变量,以PH为因变量进行多因素Logistic回归分析显示,年龄、心房颤动、脑钠尿肽是PH的影响因素（均P〈0.05）。生存曲线分析显示,HFpEF有PH组死亡率高于HFpEF无PH组（log-rank P=0.038）。以年龄、性别、PH为协变量,进行多因素Cox回归分析显示,HFpEF有PH组患者生存率降低（RR=0.538,95%CI0.328~0.884,P=0.014）。结论住院的HFpEF患者PH常见,与年龄、脑钠尿肽和心房颤动独立相关,HFpEF出现PH后生存率降低。

Objective To examine the clinical characteristics and prognosis of pulmonary hypertension（PH）in hospitalized patients experiencing heart failure with preserved ejection fraction（HFpEF）. Methods From January2009 to December 2011,a total of 200 hospitalized HFpEF patients were enrolled in this study. The clinical characteristics and prognosis of PH in hospitalized HFpEF patients were analyzed using pulmonary artery systolic pressure（PASP）measured by echocardiography. Results Out of 200 HFpEF patients,134（67%）showed tricuspid regurgitation in echocardiography and of them 79（58%）were diagnosed as PH（≥40mm Hg）. Larger pulse pressure and higher brain natriuretic peptide（BNP）level were observed in HFpEF patients with than without PH（both P〈0.05）. There were no significant medicational differences between HFpEF patients with and without PH.Multivariate logistic regression analysis showed that PH was independently associated with age,atrial fibrillation and BNP（all P〈0.05）,when using gender,age,body mass index,atria fibrillation and BNP as independent variables and PH as the dependent variable. Kaplan-Meier analysis showed that compared to HFpEF patients without PH,mortality rate was higher in HFpEF patients with HP（Log rank P=0.038）. After using age,gender and PH as concomitant variables,Cox regression analysis showed that the survival rate was reduced in HFpEF patients with PH compared to those without（relative risk=0.538,95% CI0.328-0.884,P=0.014）. Conclusions PH that is common in hospitalized HFpEF patients is independently associated with age,BNP,atrial fibrillation,and its presence may reduce the survival rate of hospitalized HFpEF patients.