扩张型心肌病继发肺动脉高压与功能性二尖瓣反流的相关性临床研究

Clinical correlation between secondary pulmonary arterial hypertension and functional mitral regurgitation in patients with dilated cardiomyopathy

目的 研究扩张型心肌病（dilated cardiomyopathy,DCM）继发肺动脉高压（pulmonary arterial hypertension,PAH）与功能性二尖瓣反流（functional mitral regurgitation,FMR）的相关性.方法 回顾性分析清华大学第一附属医院心脏中心2010年8月至2017年8月间住院的105例扩张型心肌病患者资料,其中男性73例、女性32例.根据肺动脉压水平将入选患者分为肺动脉高压组（65例）和非肺动脉高压组（40例）.所有患者入院后收集一般资料[年龄、性别、体重指数（BMI）、心率、心房颤动、高血压、糖尿病、NYHA分级],并检测血红蛋白（HGB）、尿酸（sUA）、肌酐（Cr）、血钠（Na）、白蛋白（sAlb）、总胆固醇（TC）、低密度脂蛋白（LDL）、高敏C反应蛋白（hs-CRP）、N端前脑钠肽（NT-proBNP）及超声心动图检测的指标[包括左心房内径（LAD）、左心室舒张末期内径（LVEDD）、有心房内径（RAD）、右心室内径（RVD）、室间隔厚度（IVS）、左心室射血分数（LVEF）、二尖瓣反流程度（MR）、肺动脉收缩压（PAP）].分析比较两组一般资料、生化指标及超声心动图结果.结果 两组资料分析比较,肺动脉高压组的NYHA分级、sUA、NT-proBNP、LAD、LVEDD、RAD、RVD、MR均高于非肺动脉高压组,差异有统计学意义（P＜0.05）;肺动脉高压组的TC、sALb、LVEF均低于非肺动脉高压组,差异有统计学意义（P均＜0.05）.两组样本根据筛选的因素,行Logistic回归分析,结果提示二尖瓣反流程度（OR=3.495,95％CI1.743～7.010,P＜0.001）与扩张型心肌病肺动脉高压的发生呈极显著正相关,左心房前后径值（OR=1.129,95％CI 1.043～1.221,P＜0.01）与扩张型心肌病肺动脉高压的发生呈显著正相关,血清白蛋白（OR=0.799,95％CI 0.693～0.992,P＜0.01）与扩张型心肌病肺动脉高压的发生呈显著负相关.结论 功能性二尖瓣反流程度加重、左心房扩大及血清白蛋白水平降低是扩张型心肌病患者继发肺动脉高压的独立危险因素,对于病情评估、指导治疗及预后评判具有重要意义.

Objective To study the correlation between secondary pulmonary arterial hypertension（ PAH ） and functional mitral regurgitation （FMR） in patients with dilated cardiomyopathy （DCM）. Methods The data of DCM patients（ n=105, 73 males and 32 females）, hospitalized in the first affiliated Hospital of Tsinghua University, was retrospectively analyzed from August 2010 to August 2017. On basis of echocardiography pulmonary artery pressure （pulmonary artery pressure PAP）, the patients were divided into pulmonary artery hypertension group（PAH group, n=65 ） and normal group（non-PAH group, n=40）. Baseline clinical data of both groups was recorded, including age, sex, body mass index, heart rate, atrial fibrillation, history of hypertension, history of diabetes and cardiac function. Meanwhile, indexes of blood hemoglobin （ HGB ）, sodium （Na）, albumin （ Alb ）, uric acid （ sUA ） , B-type natriuretic peptide （NT-proBNP）, serum creatinine （SCr） , high-sensitivity C-reactive protein（hs-CRP ）, cholesterol and lower density lipoprotein were detected. Echocardiographic parameters of both groups were measured, including left atrial diameter （LA） , left ventricular end diastolic diameter （LVEDD） ,right atrial diameter （RAD） , right ventricular diameter （RVD）, interventricular septum （IVS） , left ventricular ejection fraction （ LVEF ）, mitral regurgitation （ MR ） and systolic pulmonary artery pressure （ SPAP ）. The general data, biochemical indexes and results of ultrasonic cardiogram were compared between 2 groups. Results The NYHA, sUA, NT-proBNP, LAD, LVD, RAD, RVD and MR were higher in PAH group than those in non-PAH group （ all P〈0.05 ）. The Alb, TC and LVEF were lower in PAH group than those in non-PAH group （ all P〈0.05 ）. The results of Logistic regression analysis showed that MR（OR=3.495, 95%CI 1.743-7.010, P〈0.001 ） , LAD （OR=1.129, 95%CI 1.043-1.221, P〈0.01） were positively correlated to PAH, and Alb （OR=0.799, 95%CI 0.693-0.992, P〈0.01 ） was negatively correlated to PAH. Conclusion The increases of MR, LAD and the decrease of sAlb are the independent risk factors of secondary PAH, which are of great significance for the evaluation of the disease, the guidance of treatment and the prognosis in patients with dilated cardiomyopathy.