摘要
目的分析肺动脉球囊扩张成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)的有效性及安全性。方法回顾性纳入2017年2月至2019年4月在北京朝阳医院进行过至少1次BPA治疗并行肺动脉压力测定,已充分抗凝治疗3个月,不能手术的CTEPH患者38例,其中男12例,女26例,中位年龄58.5(52.5,66.0)岁。采集患者基线资料及每次BPA前的WHO功能分级、6 min步行距离、平均肺动脉压(mPAP)、肺血管阻力(PVR)、N末端B型利钠肽原(NT-proBNP)及超声心动图等指标。结果38例患者共进行95次BPA治疗。行BPA前mPAP为50(43,56)mmHg(1 mmHg=0.133 kPa),行至少1次BPA后mPAP为41(32,50)mmHg(P<0.001)。17例患者完成3~5次BPA,mPAP由50(42,55)降至34(28,49)mmHg(P<0.01)。15例患者的PVR从852(583,1140)dyn·s·cm^-5降至496(406,802)dyn·s·cm^-5(P<0.01)。BPA前WHO功能分级Ⅰ/Ⅱ级患者13例,Ⅲ/Ⅳ级患者25例,BPA治疗后WHO功能分级Ⅰ/Ⅱ级患者29例,Ⅲ/Ⅳ级患者9例(P<0.001)。BPA后6 min步行距离从360(290,442)m增加至449(376,505)m(P<0.05)。肺灌注Meyer评分从0.54(0.53,0.58)降至0.50(0.44,0.58,P<0.001)。21例患者的NT-proBNP从1285(606,2794)ng/L降至472(148,745)ng/L(P<0.05)。右心室基底内径由术前的54(41,54)mm降至42(34,49)mm(P<0.001)。6例次发生不良反应,发生率为6.3%(6/95)。结论对于不能行肺动脉血栓内膜剥脱术的CTEPH患者,BPA可有效降低肺动脉压力及肺血管阻力,改善肺灌注及右心功能,且安全性高,是CTEPH较为有效的治疗方法。
Objective To analyze the efficacy and safety of Balloon Pulmonary Angioplasty(BPA)in patients with Chronic Thromboembolic Pulmonary Hypertension(CTEPH).Methods A total of 38 CTEPH patients received at least one BPA treatment between February 2017 and April 2019 were enrolled.World Health Organization functional class(WHO-FC),6-minute walking distance(6WMD),mean pulmonary artery pressure(mPAP),pulmonary vascular resistance(PVR),N-terminal pro brain natriuretic peptide(NT-proBNP)and echocardiographic indicators were collected at baseline and before each BPA procedure.Results 38 patients received 95 times of BPA[2(1,4)times per person]totally.MPAP was 50(43,56)mmHg(1 mmHg=0.133 kPa)before BPA and 41(32,50)mmHg after at least one BPA procedure,P<0.001.MPAP decreased from 50(42,55)to 34(28,49)mmHg(P=0.003)in 17 cases after 3-5 BPA procedures.In 15 cases,PVR decreased from 852(583,1140)dyn·s·cm^-5 to 496(406,802)dyn·s·cm^-5,P=0.009.Besides,there were 13 patients with WHO Function ClassⅠ/Ⅱbefore BPA,25 patients withⅢ/Ⅳclass before BPA,29 patients withⅠ/Ⅱclass after BPA treatment,and 9 patients withⅢ/Ⅳafter BPA treatment,P<0.001.6 WMD before and after BPA increased from 360(290,442)m to 449(376,505)m,P=0.015.The Meyer score of lung perfusion scanning got improved,from 0.54(0.53,0.58)to 0.50(0.44,0.58),P<0.001.Among all registered patients,21 of whom NT-proBNP decreased from 1285(606,2794)to 472(148,745),P=0.014.The inner diameter of the right ventricular decreased from 54(41,54)mm before surgery to 42(34,49)mm after surgery,P<0.001.6(6.3%,6/95)complications occurred in 95 times of BPA.Conclusion For inoperable patients with CTEPH,BPA can significantly improve disease severity,6 MWD,heart function,decrease mPAP,PVR and improve lung perfusion,which is a safe and effective therapy.
作者
丁媛
龚娟妮
王剑锋
黄强
刘琳
焦小净
汪薇
杨媛华
Ding Yuan;Gong Juanni;Wang Jianfeng;Huang Qiang;Liu Lin;Jiao Xiaojing;Wang Wei;Yang Yuanhua(Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing Institute of Respiratory Medicine,Beijing 100020,China;Department of Interventional Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2020年第12期1049-1054,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金(31670928)。