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  • 李文婷,吴常伟,袁平,等.二维超声心动图评价肺动脉高压患者靶向药物疗效的价值[J].同济大学学报(医学版),2020,41(5):575-581.    [点击复制]
  • LI Wen-ting,WU Chang-wei,YUAN Ping,et al.Value of two-dimensional echocardiography in evaluating the efficacy of targeted therapy in patients with pulmonary hypertension[J].同济大学学报(医学版),2020,41(5):575-581.   [点击复制]
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二维超声心动图评价肺动脉高压患者靶向药物疗效的价值
李文婷,吴常伟,袁平,刘锦铭
0
(同济大学附属上海市肺科医院结核科,上海200433;同济大学附属上海市肺科医院急诊科,上海200433;同济大学附属上海市肺科医院肺循环科,上海200433)
摘要:
目的分析肺动脉高压(pulmonary hypertension, PH)患者经靶向药物治疗前后右心导管及二维超声心动图参数的变化,并探讨超声参数变化与肺血管阻力、氨基末端脑利钠肽前体(NT-pro BNP)变化的相关性。方法回顾性分析2015年10月至2019年3月住院PH患者31例,比较患者经靶向药物治疗前后血流动力学参数、NT-pro BNP、6min步行距离及二维超声心动图参数的变化,并分析超声参数变化和肺血管阻力及NT-pro BNP变化的相关性。结果PH患者在靶向药物治疗后,6min步行距离延长,NT-pro BNP降低(P<0.05)。血流动力学参数中,肺动脉平均圧、肺血管阻力、平均右心房压降低,心排血指数升高(P<0.05);超声心动图参数中,右心室基底横径和右心室游离壁厚度缩小,超声估测的肺动脉收缩压降低。三尖瓣环收缩期位移、三尖瓣环收缩期峰值运动速度延长(P<0.05)。治疗前后的三尖瓣环收缩期位移、三尖瓣环收缩期峰值运动速度的差值和肺血管阻力的差值呈负相关(r=-0.5,P=0.007;r=-0.462,P=0.018),超声估测的肺动脉收缩压的差值和肺血管阻力的差值呈正相关(r=0.430,P=0.022)。治疗前后的右心房左右径、右心室基底横径的差值和NT-pro BNP的差值呈正相关(r=0.548,P=0.002;r=0.684,P<0.001),三尖瓣环收缩期位移的差值和NT-pro BNP的差值呈负相关(r=-0.449,P=0.013)。结论二维超声心动图参数可反映PH患者靶向药治疗后右心结构的逆转和右心收缩功能的增强,且其变化与血流动力学参数及心力衰竭程度相关性好,是评价PH患者靶向药物疗效的可靠且无创工具。
关键词:  肺动脉高压  靶向药物  血流动力学  超声心动图
DOI:10.16118/j.1008-0392.2020.05.006
投稿时间:2019-12-01
基金项目:国家重点研发计划(2018YFC1313603)
Value of two-dimensional echocardiography in evaluating the efficacy of targeted therapy in patients with pulmonary hypertension
LI Wen-ting,WU Chang-wei,YUAN Ping,LIU Jin-ming
(Dept. of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China;Dept. of Emergency, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China;Dept. of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China)
Abstract:
ObjectiveTo evaluate the application of right-heart catheterization(RHC) and two-dimensional(2-d) echocardiography in assessment the efficacy of targeted therapy for patients with pulmonary hypertension(PH). MethodsClinical data of 31 patients with PH from October 2015 to March 2019 were retrospectively analyzed. The changes of hemodynamic parameters, n-terminal natriuretic peptide type-B(NT-pro BNP), 6min-walk distance(6MWD) and 2-d echocardiographic parameters were compared before and after targeted therapy; the correlations of the changes of echocardiography parameters with pulmonary vascular resistance(PVR) and NT-pro BNP were analyzed. ResultsAfter targeted therapy, the 6MWD increased and NT-pro BNP decreased in patients. Hemodynamic parameters including mean pulmonary artery pressure(mPAP), PVR, mean right atrial pressure(mRAP) decreased, and cardiac output index(CI) increased. Echocardiographic parameters including the right ventricular transverse diameter(RVd), the thickness of the free wall of the right ventricle(RVWT) and the pulmonary artery systolic pressure(PASP) decreased. The tricuspid annular plane systolic excursion(TAPSE) and the peak systolic velocity of tricuspid annulus(Smax) increased(all P<0.05). The changes of TAPSE and Smax were negatively correlated with the change of PVR(r=-0.5,P=0.007;r=-0.462,P=0.018). The change of PASP estimated by echocardiography were positively correlated with those of PVR(r=0.430,P=0.022). The changes of right atrial diameter(RAd) and RVd were positively correlated with those of NT-pro BNP(r=0.548,P=0.002;r=0.684,P<0.001), and the change of TAPSE was negatively correlated with the change of NT-pro BNP(r=-0.449,P=0.013). ConclusionThe parameters of 2-d echocardiography can reflect the reverse of the right cardiac structure and the improvement of systolic function of right heart after targeted therapy in patients with PH, and these changes are well correlated with the changes of hemodynamics and severity of heart failure, indicating that 2-d echocardiography is a reliable non-invasive tool in follow-up of patients with PH after treatment.
Key words:  pulmonary hypertension  targeted drug  hemodynamic  echocardiography

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