特发性扩张型心肌病合并肺动脉高压患者的超声心动图和相关实验室指标的特征分析

Characteristics of echocardiography and related laboratory parameters in patients with idiopathic dilated cardiomyopathy complicated with pulmonary hypertension

目的分析特发性扩张型心肌病(IDCM)患者的超声心动图和相关实验室指标,探讨在IDCM及左心疾病患者中预测肺动脉高压(PAH)的敏感指标。方法选取该院确诊为IDCM的患者82例为研究对象,依据三尖瓣反流峰值速度及其他超声心动图结果进行PAH发生的可能性分组,其中低度可能性组32例,中度和高度可能性组均为25例,对3组患者的一般资料、超声心动图及相关实验室指标进行分析;将低度可能性和中度可能性归为1组,对相关系数绝对值≥0.3的指标绘制受试者工作特征曲线(ROC曲线),分析各指标对预测PAH发生高度可能性的诊断价值;采用多因素Logistic回归分析筛选PAH发生高度可能性的影响因素,绘制ROC曲线评估影响因素联合预测的价值。结果随着PAH发生可能性的增加,左房内径(LAD)、左室舒张末期内径(LVEDD)、肺动脉内径(PAD)、PAD/主动脉内径(AOD)、红细胞分布宽度(RDW),以及脑钠肽(BNP)、总胆红素(TBIL)、结合胆红素(DBIL)、直接胆红素(IBIL)水平升高;左室射血分数(LVEF),以及淋巴细胞(Lym)、高密度脂蛋白(HDL)水平降低,3组比较差异均有统计学意义(P<0.05),且上述各指标与PAH发生的可能性均相关(P<0.05)。ROC曲线分析结果表明,LVEF、Lym、BNP、TBIL、IBIL、DBIL、HDL对预测PAH发生的高度可能性有较高诊断价值(AUC>0.70,P<0.05);LAD、PA、PAD/AOD、RDW对预测PAH发生的高度可能性有较低诊断价值(AUC<0.7,P<0.05)。多因素Logistic回归分析结果表明,PAD、RDW、Lym、HDL是PAH发生的影响因素,上述4项指标联合检测的灵敏度为0.833,特异度为0.825。结论PAD、RDW、Lym、HDL达到最佳临界值时应高度怀疑IDCM合并PAH,这4项指标可为IDCM合并PAH的诊断、治疗和预后评价提供依据。

Objective To analyze the echocardiography and related laboratory parameters in patients with idiopathic dilated cardiomyopathy(IDCM),and to explore the sensitive indicators for predicting pulmonary hypertension(PAH)in patients with IDCM and left heart disease.Methods A total of 82 patients with IDCM in our hospital were selected.According to the peak velocity of tricuspid regurgitation and other echocardiography results,the possibility of PAH was divided into three groups including 32 cases in low probability group,25 cases in moderate and high possibility group.Low probability and moderate probability were divided into one group,and receiver operating characteristic curve(ROC curve)was drawn for the indexes with correlation coefficient absolute value≥0.3,and the diagnostic value of each index in predicting the high probability of PAH occurrence was analyzed.The general information,echocardiography and related laboratory parameters of the three groups were divided.Multivariate Logistic regression analysis was used to screen influence factors of PAH,and ROC curve was drawn to evaluate the value of joint prediction of influence risk factors.Results With the increase of the possibility of PAH,the left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),pulmonary artery diameter(PAD),PAD/aortic diameter(AOD),red blood cell distribution width(RDW),and the levels of brain natriuretic peptide(BNP),total bilirubin(TBIL),conjugated bilirubin(DBIL),direct bilirubin(IBIL)were increased;left ventricular ejection fraction(LVEF),lymphocyte(Lym)and high density lipoprotein(HDL)levels were significantly lower in the three groups(P<0.05),and the above indicators were correlated with the possibility of PAH(P<0.05).The results of ROC curve analysis showed that LVEF,Lym,BNP,TBIL,IBIL,DBIL,HDL had high diagnostic value in predicting the high possibility of PAH(AUC>0.70,P<0.05);LAD,PA,PAD/AOD and RDW had low diagnostic value in predicting the high possibility of PAH(AUC<0.7,P<0.05).The results of multivariate logistic regression analysis showed that PAD,RDW,Lym and HDL were influence factors for PAH.The sensitivity and specificity of the combined detection of the above four indicators were 0.833 and 0.825,respectively.Conclusion When PAD,RDW,Lym and HDL reach the optimal critical value IDCM with PAH be highly suspected.These four indexes can provide basis for the diagnosis,treatment and prognosis evaluation of IDCM with PAH.