风湿性心脏病二尖瓣病变肺动脉高压影响因素分析

FACTORS OF PULMONARY HYPERTENSION IN PATIENTS WITH RHEUMATIC HEART DISEASE MITRAL LESION

目的:探讨风湿性心脏病二尖瓣病变患者发生肺动脉高压的影响因素。方法:回顾性分析风湿性心脏病二尖瓣病变肺动脉高压患者177例的临床资料及超声心动图等检查指标,与同期181例正常体检者进行比较。采用多重线性回归分析及多因素Logistic回归分析风湿性心脏病二尖瓣病变患者发生肺动脉高压的影响因素。结果:(1)以肺动脉收缩压为因变量,以房颤(X1)、肺淤血(X2)为自变量,得到多重线性回归方程:Y=62.37-5.37 X1+3.10 X2(F=3.506,P=0.03);(2)对单因素分析中有统计学意义的5个变量进行多因素逐步Logistic回归分析,结果显示二尖瓣口面积(MVA)、左房最大体积(LAVmax)、二尖瓣反流压差(MRP)、二尖瓣反流量(MRV)、二尖瓣前向血流速度时间积分(VTI)的回归系数(β)分别为-0.47、0.20、0.05、0.85、0.48(均P<0.05)。结论:房颤、MVA是肺动脉高压的保护因素,肺淤血、LAVmax、MRP、MRV、VTI是肺动脉高压的危险因素。

Objective： To investigate the factors of the pulmonary hypertension in patients with rheumatic heart disease mitral lesion. Methods： A total of 177 cases of rheumatic heart disease mitral lesion patients with pulmonary hypertension were retrospectively analyzed. Patients＇ clinical data and echocardiogram in- dex were compared with 181 healthy participants who attended the same physical examination. Multiple linear regression and multiple factor logistic regression were used to analyze the factors of pulmonary hy- pertension in patients with rheumatic heart disease mitral lesion. Results： Multiple linear regression equation was Y=62.37-5.37X1 ＋3.10X2 （F=3. 506, P =0.03） ,with the pulmonary artery systolic pressure as de- pendent variable,and the atrial fibrillation （X1）, pulmonary congestion （X2） as independent variable. Step- wise logistic regression was used to analyze five variables which were statistical significance in single factor analysis. The results showed that the regression coefficient of mitral valve area （MVA） ,left atrial maximum volume （LAVmax）, mitral valve regurgitation pressure （MRP） , Mitral regurgitation volume （MRV）,Mitral anterior flow velocity Time integral （VTI） were -0.47,0.20,0. 049,0. 851 and 0.48,respectively（all P〈 0. 05）. Conclusion： The atrial fibrillation and MVA are protective factors for PH. LVA MRP, MRV and VTI are the risk factors for pulmonary arterial hypertension in patients with rheumatic heart disease mitral lesion.