结缔组织病相关肺动脉高压合并心包积液患者临床特点分析

Clinical feature analysis of pericardial effusion in patients with connective tissue disease associated pulmonary arterial hypertension

目的:探讨心包积液与结缔组织病相关肺动脉高压(CTD-PAH)病情的关系。方法:回顾性分析经右心导管检查诊断的61例CTD-PAH患者的临床资料,根据超声心动图结果分为有心包积液组(n=33)和无心包积液组(n=28),比较两组的年龄、世界卫生组织心功能分级(WHO Fc)、免疫及炎症指标、超声心动图及右心导管检查结果的差异。分析心包积液量与免疫炎症指标、心功能指标等的相关性。结果:61例患者男女比例为1:60,平均年龄(43.4±14.6)岁。心包积液组较无心包积液组血尿酸[(402.8±125.0)μmmol/L vs.(326.2±103.4)μmmol/L,P<0.05]、N末端B型利钠肽原[(1345.5±1167.5)pg/mL vs.(326.4±458.1)pg/mL,P<0.05]、平均右心房压[(6.8±4.1)mmHg vs.(4.9±2.1)mmHg,P<0.05]、右心室舒张末压[(10.6±3.8)mmHg vs.(8.5±3.6)mmHg,P<0.05]、右心房舒张末期横径[(49.5±6.4)mm vs.(41.8±7.6)mm,P<0.05]、右心室舒张末期横径[(43.0±5.5)mm vs.(36.9±8.2)mm,P<0.05]及肺动脉收缩压[(89.5±23.0)mmHg vs.(74.4±23.6)mmHg,P<0.05]更高。心包积液量与血尿酸、NT-proBNP、mRAP、RVEDP、RAD及RVD值呈正相关(r=0.31、0.54、0.28、0.36、0.40、0.33,均P<0.05)。SLE病情活动的患者较病情相对缓解的患者出现心包积液的比例更高[(16/24)vs.(2/6),P=0.14]。结论:心包积液是CTD-PAH患者常见的临床表现,可能与右心功能相关。

Objective:To investigate the relationship between pericardial effusion and connective tissue disease-associated pulmonary arterial hypertension(CTD-PAH).Methods:The clinical data of 61 patients with CTD-PAH diagnosed by right heart catheterization in the General Hospital of Tianjin Medical University from October 2008 to May 2016 were retrospectively analyzed.According to the results of echocardiography,these patients were divided into pericardial effusion group(n=33)and non-pericardial effusion group(n=28),and the age,WHO Fc,immune and inflammation indicators of the two groups were compared.Echocardiography and right heart catheterization results were compared.The correlation between the volume of pericardial effusion and the indexes of immune inflammation and cardiac function were analyzed.Results:The ratio of male to female in 61 patients was 1:60,with an average age of(43.4±14.6)years.Pericardial effusion group had higher blood uric acid[(402.8±125.0)μmmol/L vs.(326.2±103.4)μmmol/L,P<0.05],N-terminal B-type natriuretic peptide[(1345.5±1167.5)pg/mL vs.(326.4±458.1)pg/mL,P<0.05],mean right atrial pressure[(6.8±4.1)mmHg vs(4.9±2.1)mmHg,P<0.05],right ventricular end-diastolic pressure[(10.6±3.8)mmHg vs.(8.5±3.6)mmHg,P<0.05],right atrial end-diastolic transverse diameter[(49.5±6.4)mm vs.(41.8±7.6)mm,P<0.05],right ventricle end-diastolic transverse diameter[(43.0±5.5)mm vs.(36.9±8.2)mm,P<0.05]and systolic pulmonary artery pressure[(89.5±23.0)mmHg vs.(74.4±23.6)mmHg,P<0.05]than those without pericardial effusion(P<0.05).The degree of pericardial effusion was positively correlated with serum uric acid,N-terminal B-type natriuretic peptide,mean right atrial pressure,right ventricular end-diastolic pressure,right atrial end-diastolic transverse diameter and right ventricle end-diastolic transverse diameter(r=0.31,0.54,0.28,0.36,0.40,0.33,all P<0.05).SLE patients with higher disease activity index were more likely to have pericardial effusions than patients with disease relative remission[(16/24)vs.(2/6),P=0.14].Conclusion:Pericardial effusion is a common clinical manifestation in patients with CTD-PAH and may be related to right heart function.