2012至2019年云南单中心肺高血压患者分类和诊治情况

Classification,diagnosis and treatment status of pulmonary hypertension from 2012 to 2019:a single center study in Yunnan province

目的分析云南单中心肺高血压(PH)患者的分类及诊治情况。方法本研究为回顾性研究。入选2012年1月至2019年12月于昆明医科大学附属延安医院住院的PH患者。通过电子病历系统收集入选患者的临床资料,包括人口统计学资料、合并症、靶向药物使用情况、超声心动图和右心导管检查结果,分析PH分类构成比和诊治情况。结果共入选13590例PH患者,占同期住院总人数的3.09%(13590/440056)。PH构成以肺动脉高压(PAH)为主[55.50%(7542/13590)],其次为左心疾病所致PH[24.16%(3284/13590)];其中,PAH可细分为特发性肺动脉高压(IPAH)、结缔组织疾病相关PAH、门脉高压相关PAH及先天性心脏病(CHD)相关PAH(CHD-PAH)4种类型,以CHD-PAH为主[98.09%(7398/7542)]。PAH患者主要以青少年为主。2012至2019年PH住院患者中,儿童、青少年占比呈逐年递减趋势,中老年占比呈增加趋势;女性患者占比呈逐渐下降趋势,合并高血压、糖尿病、冠状动脉疾病、心律失常、肺炎者占比均呈递增趋势。行右心导管检查的患者共1034例[7.61%(1034/13590)]。超声心动图与右心导管检查结果的一致率为[86.98%(875/1006)]。PH患者中予以PAH靶向药物治疗的共2574例(18.94%),其中使用单药治疗者占58.16%(1497/2574)。使用靶向药物的PH患者中,主要以PAH患者为主[86.44%(2225/2574)],其中CHD-PAH患者占83.53%(2150/2574)。结论2012至2019年本中心住院的PH患者以CHD-PAH为主,接受右心导管检查和靶向药物治疗的比例较低,中老年PH患者占比呈逐年递增趋势,同时伴随合并症者占比也呈增长趋势。

ObjectiveTo analyze the classification,diagnosis and treatment status of patients with pulmonary hypertension(PH)in Yunnan province.MethodsThis was a retrospective study.Hospitalized patients with PH at Yan′an Affiliated Hospital of Kunming Medical University from January 2012 to December 2019 were enrolled.The clinical data of enrolled patients,including demographic data,comorbidities,targeted drug therapy,echocardiography and right heart catheterization results,were obtained through the electronic medical record system.The composition ratio of PH,diagnosis and treatment were analyzed.Results A total of 13590 patients with PH were enrolled,accounting for 3.09%(13590/440056)of the total number of hospitalizations during the same period.The composition of PH was predominantly pulmonary arterial hypertension(PAH)(55.50%(7542/13590)),followed by pulmonary hypertension(PH)caused by left heart disease(24.16%(3284/13590)).Among them,PAH could be subdivided into four types:idiopathic pulmonary arterial hypertension(IPAH),PAH associated with connective tissue disease,PAH associated with portal hypertension,and PAH associated with congenital heart disease(CHD-PAH),with CHD-PAH as the predominating type(98.09%(7398/7542)).Patients with PAH were predominantly adolescents.In hospitalized patients with PH,from 2012 to 2019,the proportion of children and adolescents showed a decreasing trend from year to year,and the proportion of middle-aged and older adults showed a significant increasing trend,and the proportion of female patients showed a gradual decreasing trend,and the proportion of patients with comorbid hypertension,diabetes mellitus,coronary artery disease,arrhythmia,and pneumonia showed an increasing trend.A total of 1034 patients(7.61%(1034/13590))underwent right heart catheterization.The concordance rate between echocardiographic and right heart catheterization findings was(86.98%(875/1006)).A total of 2574(18.94%)of PH patients were treated with PAH targeted drugs,of which 58.16%(1497/2574)were treated with monotherapy.Among the PH patients treated with PAH targeted drugs,the majority of patients were PAH patients(86.44%(2225/2574)),and 83.53%(2150/2574)patients treated with PAH targeted drugs were CHD-PAH.ConclusionsHospitalized PH patients in our center between 2012 and 2019 are predominantly CHD-PAH,and the proportion of patients receiving right heart catheterization and targeted drug therapy is relatively low.The percentage of middle-aged and elderly PH patients shows an increasing trend from year to year,as well as the percentage of those with concomitant comorbidities.