摘要
目的 探讨超声心动图评估安立生坦联合西地那非对重度肺动脉高压(PAH)患者右心室-肺动脉耦联(RVPAC)影响的可行性及临床相关因素。方法 选取33例重度PAH患者作为研究对象,给予安立生坦(5~10 mg/d)和西地那非(50 mg/d)连续治疗至少6个月。采用酶联免疫吸附试验(ELISA)法检测血浆N末端-B型利钠肽前体(NT-proBNP)水平,并检测平均肺动脉压(mPAP)、肺动脉楔压(PAWP)、肺血管阻力(PVR)和心脏指数(CI);使用超声心动图测量患者常规超声参数,并计算RVPAC指标,包括右心室面积变化分数(RVFAC)/肺动脉收缩压(PASP)、三尖瓣环平面收缩偏移(TAPSE)/PASP、三尖瓣环收缩期速度(S′)/PASP和右心室每搏量(RVSV)/右心室收缩末容积(RVESV)。治疗后常规随访6个月,并记录患者临床预后,以死亡为终点事件。采用二分类Logisitc回归分析法分析RVPAC指标与患者预后的关联;绘制受试者工作特征(ROC)曲线,分析RVPAC指标预测临床预后的效能。结果 33例患者治疗6个月后NT-proBNP水平为356.7(141.8,1 126.2) pg/mL,低于治疗前的1 748.4(696.8,3 012.4) pg/mL,差异有统计学意义(P<0.001)。相较于治疗前,患者治疗后S′、TAPSE、右心室射血分数(RVEF)、RVFAC升高,PASP、RVESV降低,RVFAC/PASP、TAPSE/PASP、S′/PASP、RVSV/RVESV升高,差异均有统计学意义(P<0.05)。Spearman检验显示,治疗前RVFAC/PASP、TAPSE/PASP、S′/PASP、RVSV/RVESV均分别与NT-proBNP、mPAP、PAWP、PVR呈负相关(P<0.001),且均分别与收缩末期弹性/肺动脉弹性(Ees/Ea)呈正相关(P<0.001)。33例患者中,6例发生终点事件。二分类Logisitc回归分析显示,治疗前RVFAC/PASP、TAPSE/PASP、S′/PASP、RVSV/RVESV降低均为终点事件的危险因素(P<0.05)。ROC曲线显示,治疗前RVFAC/PASP、TAPSE/PASP、S′/PASP和RVSV/RVESV预测临床预后的曲线下面积分别为0.839、0.745、0.768和0.856。结论 安立生坦联合西地那非治疗重度PAH可显著改善RVPAC,基于超声心�
Objective To explore the feasibility and clinical relevant factors of ambrisentan combined with sildenafil evaluated by echocardiograph in right ventricular pulmonary arterial coupling(RVPAC)patients with severe pulmonary hypertension(PAH).Methods A total of 33 patients with severe PAH were selected as research objects,ambesentan(5 to 10 mg/d)and sildenafil(50 mg/d)were given for at least 6 months.Plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)was detected by Enzyme linked immunosorbent assay(ELISA).Mean pulmonary artery pressure(mPAP),pulmonary arterial wedge pressure(PAWP),pulmonary vascular resistance(PVR)and cardiac index(CI)were measured by right heart catheterization.Conventional ultrasonic parameters were measured by echocardiography,and RVPAC related indexes including right ventricular fractional area change/pulmonary arterial systolic pressure(RVFAC/PASP),tricuspid annular plane systolic excursion(TAPSE)/PASP,tricuspid annular systolic velocity(S′)/PASP and right ventricular stroke volume(RVSV)/right ventricular end systolic volume(RVESV)were calculated.The patients were followed up for 6 months,clinical prognosis was recorded,and end event was death.The correlations between RVPAC indexes and prognosis were analyzed by binary Logistic regression;receiver operating curve(ROC)was used to analyze the efficacy of RVPAC indexes for predicting clinical prognosis.Results The level of NT-proBNP in 33 patients after 6 months treatment was significantly lower than before treatment[356.7(141.8,1126.2)pg/mL versus 1748.4(696.8,3012.4)pg/mL,P<0.001].After treatment,S′,TAPSE,right ventricular ejection fraction(RVEF)and RVFAC increased significantly,while PASP and RVESV decreased significantly,RVFAC/PASP,TAPSE/PASP,S′/PASP and RVSV/RVESV also increased significantly compared with before treatment(P<0.05).Spearman test showed that RVFAC/PASP,TAPSE/PASP,S′/PASP and RVSV/RVESV were separately negatively correlated with NT-proBNP,mPAP,PAWP and PVRbefore treatment(P<0.001),and were all positively correla
作者
诸玮
芮云云
刘倩
丁晓军
陈刚
ZHU Wei;RUI Yunyun;LIU Qian;DING Xiaojun;CHEN Gang(Department of Ultrasound,Gaochun Branch of Nanjing Drum Tower Hospital of Jiangsu Province,Nanjing,Jiangsu,211300;Department of Respiratory Medicine,Gaochun Branch of Nanjing Drum Tower Hospital of Jiangsu Province,Nanjing,Jiangsu,211300)
出处
《实用临床医药杂志》
CAS
2023年第7期12-17,共6页
Journal of Clinical Medicine in Practice
基金
2020年江苏省重点研发计划专项资金(BE2020718)。
关键词
超声心动图
安立生坦
西地那非
肺动脉高压
右心室-肺动脉耦联
echocardiography
ambrisentan
sildenafil
pulmonary arterial hypertension
right ventricular pulmonary artery coupling
