右心房功能参数与慢性阻塞性肺疾病合并肺动脉高压患者预后的相关性

Correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

目的探讨右心房功能参数与慢性阻塞性肺疾病(COPD)合并肺动脉高压患者预后的相关性。方法回顾性选取2020年2月至2022年6月新疆医科大学第一附属医院收治的84例采用波生坦联合米力农治疗的COPD合并肺动脉高压患者作为研究对象,根据治疗效果将其分为有效组(63例)和无效组(21例)。于治疗前采用Philips iE33彩色超声诊断仪对患者的右心功能进行检测,采用Logistic回归分析影响患者治疗效果的危险因素,采用受试者工作特征(ROC)曲线分析右心房功能参数对COPD合并肺动脉高压患者不良预后的预测价值。结果有效组主肺动脉内径(MPA)、右心室基底横径(RVd1)、右心室中部横径(RVd2)、右心房左右径(RAd)、右心室游离壁厚度低于无效组[(2.65±0.23)cm比(2.90±0.44)cm、(3.46±0.43)cm比(3.76±0.72)cm、(3.48±0.42)cm比(3.88±0.69)cm、(3.53±0.81)cm比(4.03±1.20)cm、(0.63±0.12)cm比(0.72±0.21)cm],舒张末期至收缩末期三尖瓣环位移(TAPSE)高于无效组[(2.08±0.32)cm比(1.82±0.46)cm],差异均有统计学意义(P<0.05)。Logistic回归分析结果表明,RVd1升高(OR=3.717,P<0.05)、RVd2升高(OR=2.162,P<0.05)、RAd升高(OR=2.838,P<0.05)和TAPSE降低(OR=1.704,P<0.05)是患者治疗无效的危险因素。ROC曲线分析结果表明,RVd1、RVd2、RAd、TAPSE预测COPD合并肺动脉高压患者治疗效果的曲线下面积分别为0.820、0.831、0.872、0.909。结论右心结构参数提高及收缩功能参数降低是COPD合并肺动脉高压患者采用波生坦联合米力农治疗无效的独立影响因素,临床医生可根据各参数水平对患者的治疗效果进行评估。

Objective To explore the correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension.Methods Eighty-four patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone admitted to the First Affiliated Hospital of Xinjiang Medical University during the period of February 2020 to June 2022 were selected as the study subjects,and they were divided into the effective group(63 cases)and the ineffective group(21 cases)according to the treatment effect.Right cardiac function parameters were measured by Philips iE33 color ultrasonography before treatment and 72 h after treatment.Logistic regression was used to analyze the risk factors affecting the treatment outcome of patients,and receiver operating characteristics(ROC)curve was used to analyze the predictive value of right atrial function parameters in the poor prognosis of patients with COPD complicated with pulmonary hypertension.Results The main pulmonary artery diameter(MPA),right ventricular base transverse diameter(RVd1),right ventricular middle transverse diameter(RVd2),right atrial diameter(RAd)and right ventricular free wall thickness(RVWT)in the effective group were lower than those in the ineffective group:(2.65±0.23)cm vs.(2.90±0.44)cm,(3.46±0.43)cm vs.(3.76±0.72)cm,(3.48±0.42)cm vs.(3.88±0.69)cm,(3.53±0.81)cm vs.(4.03±1.20)cm,(0.63±0.12)cm vs.(0.72±0.21)cm;end-diastolic to end-systolic tricuspid ring displacement(TAPSE)was higher than that in the ineffective group:(2.08±0.32)cm vs.(1.82±0.46)cm,there were statistical differences(P<0.05).Logistic regression analysis showed that RVd1 increased(OR=3.717,P<0.05),RVd2 increased(OR=2.162,P<0.05),RAd increased(OR=2.838,P<0.05)and TAPSE reduction(OR=1.704,P<0.05)were risk factors for treatment failure in patients.The results of ROC curve showed that the area under the curve of RVd1,RVd2,RAd,TAPSE in predicting the therapeutic effect of COPD patients with pulmonary hypertension were 0.820,0.831,0.872,0.909,respectively.Conclusions The independent influencing factors of ineffective patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone are the increase of structural parameters of the right heart and the decrease of systolic function parameters.The therapeutic effect of patients can be evaluated clinically according to the level of each parameter.