妊娠对先天性心脏病相关肺动脉高压患者远期预后影响的初步研究

Effects of pregnancy on long-term outcomes of pulmonary arterial hypertension associated with congenital heart disease： a preliminary study

目的 探讨妊娠对先天性心脏病相关肺动脉高压（PAH-CHD）患者远期预后的影响.方法 回顾性分析2004-2013年北京安贞医院收治且获得随访的40例合并PAH-CHD孕产妇患者（妊娠组）的临床资料,以1∶1比例选择同期未妊娠的40例PAH-CHD女性患者为对照（对照组）,于2016年4-10月随访两组患者的生存结局、心功能状况（远期心功能分级）,比较两组远期临床结局的差异.结果 平均随访（6.5±1.9）年.两组均无死亡病例.妊娠组与对照组的远期心功能纽约心脏病协会（NYHA）分级Ⅰ～Ⅳ级分别为13、19、6、2例与16、17、7、0例,差异无统计学意义（Z=-1.41,P=0.16）.调整年龄、随访时间、靶向药物治疗、艾森门格综合征后显示,妊娠对PAH-CHD患者远期心功能恶化的影响无统计学意义（P=0.70,OR=1.32,95％ CI：0.33 ～5.37）.结论 妊娠对PAH-CHD患者的远期心功能预后可能无明显影响.

Objective To investigate the effects of pregnancy on long-term outcomes of pulmonary arterial hypertension associated with congenital heart disease （PAH-CHD）.Methods Women with PAH-CHD who had undergone pregnancy under the care of Beijing Anzhen Hospital from 2004 to 2013 were retrospectively identified and 1∶1 matched to nulliparous PAH-CHD females （controls）.Functional status and other clinical data were recorded for each group at baseline and follow-up.Results We successfully matched 40 pairs of pregnant and non-pregnant women with PAH-CHD.The patients were followed up for a mean of （6.5 ± 1.9） years,the outcomes of patients were documented during April 2016 to October 2016.No deaths occurred in either group during the study period.There were no statistically significant differences in long-term cardiac function between the two groups （Z =-1.41,P =0.16）.After adjusting age,timing of follow-up,specific drug therapy and Eisenmenger＇s syndrome,pregnancy didn＇t have significant effect on the long-term deterioration of cardiac function in PAH-CHD patients （OR =1.32,95％ CI：0.33-5.37,P =0.70）.Conclusion Pregnancy may not have significant effect on long-term cardiac function in PAH-CHD patients,but this conclusion needs to be confirmed by further studies.