肺动脉高压患者肝中静脉血流频谱参数、三尖瓣环收缩期位移与右心功能的相关性分析

Correlation analysis of middle hepatic vein blood flow spectrum parameters,tricuspid annular plane systolic excursion and right ventricular function in patients with pulmonary hypertension

目的探讨不同程度肺动脉高压(PH)患者肝中静脉血流频谱参数、三尖瓣环收缩期位移(TAPSE)与右心功能的相关性。方法选取我院收治的PH患者108例,根据平均肺动脉压分为轻度组38例,中度组44例,重度组26例;另选同期我院健康体检者40例为对照组。比较各组TAPSE及右心功能参数,包括右室收缩末期容积(RVESV)、右室舒张末期容积(RVEDV),右室每博量(RVSV)、右室射血分数(RVEF)、二尖瓣和三尖瓣舒张早、晚期峰值血流速度(E、A)、E/A及Tei指数,测量TAPSE;记录肝中静脉血流频谱,测量肝中静脉内径(D)、峰值血流速度(Vmax)、充盈指数(CI);分析肝中静脉血流频谱参数和TAPSE与右心功能的相关性。结果RVESV、RVEDV、二尖瓣A、三尖瓣A、Tei指数、D、CI、Vmax在重度组、中度组、轻度组、对照组中均依次降低,TAPSE、RVSV、RVEF、二尖瓣E、三尖瓣E、二尖瓣E/A、三尖瓣E/A在重度组、中度组、轻度组、对照组中均依次增高,各组两两比较差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,PH患者D与RVSV、RVEF均呈负相关,与二尖瓣A、三尖瓣A均呈正相关(均P<0.05);Vmax与RVEDV、RVESV、Tei指数、二尖瓣E、二尖瓣E/A、三尖瓣E、三尖瓣E/A均呈正相关(均P<0.05);CI与RVEDV、RVESV、Tei指数、二尖瓣E、二尖瓣E/A、三尖瓣E、三尖瓣E/A均呈正相关,与RVSV、RVEF、二尖瓣A、三尖瓣A均呈负相关(均P<0.05);TAPSE与RVEDV、RVESV、Tei指数均呈负相关,与RVSV、RVEF、二尖瓣E、二尖瓣E/A、三尖瓣E、三尖瓣A、三尖瓣E/A均呈正相关(均P<0.05)。结论PH患者肝中静脉血流频谱参数、TAPSE与右心功能具有一定相关性,且其对临床评估PH患者右心功能有一定应用价值。

Objective To explore the relationship between the blood flow spectrum parameters of middle hepatic vein,tricuspid annular plane systolic excursion(TAPSE)and right ventricular function in patients with different degrees of pulmonary arterial hypertension(PH).Methods A total of 108 PH patients admitted to our hospital were selected.According to the mean pulmonary artery pressure,the patients were divided into mild group with 38 patients,moderate group with 44 patients,and severe group with 26 patients.In addition,a total of 40 healthy subjects for a physical examination during the same period were selected as the control group.TAPSE and right heart functional indexes including right ventricular end-systolic volume(RVESV),right ventricular end-diastolic volume(RVEDV),right ventricular stroke volume(RVSV),right ventricular ejection fraction(RVEF),peak flow velocity of mitral valve and tricuspid valve in early and late diastole(E,A),E/A and Tei index among the groups were compared.The blood flow spectrum parameters of the middle hepatic vein including diameter(D),peak velocity(Vmax),congestion index(CI)were measured,and the correlation between the blood flow spectrum parameters of the middle hepatic vein,TAPSE and right ventricular function were analyzed.Results RVEDV,RVESV,mitral A,tricuspid A,Tei index,D,CI,and Vmax decreased gradually in severe group,moderate group,mild group and control group,while TAPSE,RVSV,RVEF,mitral E,tricuspid E,mitral valve E/A,and tricuspid valve E/A increased gradually in severe group,moderate group,mild group and control group,the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that D was negatively correlated with RVSV and RVEF,and positively correlated with mitral valve A and tricuspid valve A(all P<0.05).Vmax was positively correlated with RVEDV,RVESV,Tei index,mitral valve E,mitral valve E/A,tricuspid valve E and tricuspid valve E/A(all P<0.05).CI was positively correlated with RVEDV,RVESV,Tei index,mitral valve E,mitral valve E/A,tricuspid valve E,tricuspid valve E/A,and negatively correlated with RVSV,RVEF,mitral valve A and tricuspid valve A(all P<0.05).TAPSE was positively correlated with RVSV,RVEF,mitral valve E,mitral valve E/A,tricuspid valve E,tricuspid valve A,tricuspid valve E/A,and negatively correlated with RVEDV,RVESV,Tei index(all P<0.05).Conclusion The blood flow spectrum parameters of middle hepatic vein and TAPSE in patients with PH have a certain correlation with right ventricular function,which have a certain application value for clinical evaluation of right heart function in patients with PH.