上腔静脉频谱指标评价肺动脉高压的应用

Application of superior vena cava spectra in prediction of pulmonary hypertension

目的：分析肺动脉高压患者上腔静脉血流频谱参数的变化规律,筛选适合临床使用的诊断肺动脉高压新指标。方法预行封堵术的先天性心脏病患者80例,经右心导管测量其肺动脉压力,经超声心动图测量上腔静脉频谱参数,通过 ROC 曲线评价上腔静脉频谱指标对肺动脉高压的预测价值,确定截断点。结果以右心导管测量的肺动脉收缩压（PASP）〉30 mmHg 为肺动脉高压的诊断标准,肺动脉高压组患者70例,对照组患者10例。肺动脉高压组中9例患者上腔静脉频谱非四相波。对上腔静脉频谱形态为四相波（肺动脉高压组患者61例,对照组患者10例）的频谱参数分析显示,肺动脉高压组收缩期回心波的峰值速度（S）降低,心室收缩末期离心波的峰值速度（VR）降低,心房收缩期离心波的峰值速度（AR）与 S 的比值（AR/S）升高,与对照组比较差异均具有统计学意义（t =2244,2063,-2896,P =0028,0043,0005）。ROC 曲线显示 AR/S 值对于肺动脉高压的诊断效果优于其他参数。以 AR/S 045为界值诊断的敏感性7377%,特异性8000%。用于区分正常与中重度肺动脉高压患者时,敏感性8286%,特异性8000%。结论以上腔静脉血流频谱 AR/S 045为界值诊断肺动脉高压具有较好的敏感性及特异性,可以作为超声心动图评价肺动脉高压的参考指标。

Objective To analyze the changes of superior vena cava SVC spectra in patients with pulmonary hypertension PH and screen the proper parameters of SVC to predict PH Methods Eighty patients with congenital heart disease who underwent right heart catheterization for the measurement of pulmonary artery pressure were included SVC Doppler ultrasound was performed before the catheterization The cut-off point of SVC parameters in the prediction of PH was analyzed using receiver operator characteristic curve ROC curve Results Eighty subjects were included and there were 61 patients in PH group and 10 patients in the control group whose spectra pattern had four waves The data of the 9 subjects whose SVC spectrum were not four waves were excluded from the analysis Diagnostic criteria for PH was pulmonary artery systolic pressure PASP more than 30 mmHg measured by right heart catheterization The analysis of the peak velocity of SVC waves showed that ventricular systolic wave S reduced ventricular reversal wave VR reduced and the ratio of atrial reversal wave and ventricular systolic wave AR S increased in the PH group Compared with the control group their differences were statistically significant t =2 244 2 063 -2 896 P =0 028 0 043 0 005 The ROC curve showed that the ratio of AR S had better diagnostic effect than other parameters On the ROC curve of AR S when the ratio of AR S was 0 45 the sensitivity was 73 77% and specificity was 80 00% respectively for predicting PH When AR S was used to distinguish the control group from patients with moderate and severe PH group the sensitivity was 82 86% and specificity was 80 00% respectively Conclusions Using the ratio of AR S 0 45 as a cut-off for prediction of PH shows a good sensitivity and specificity which might be an＆amp;nbsp;alternative method for assessing PH 〈br〉 alternative method for assessing PH.