目的：评价结缔组织病（CTD）合并肺高压（PH）的发病率、临床特点及超声表现。方法：回顾性分析2014年6月—2016年12月我院风湿免疫科1 729例住院患者的超声心动图检查资料，根据肺动脉收缩压（sPSP）≥36 mmHg（1 mmHg≈0.133 kPa），从中筛选出PH患者，按sPAP程度分为Ⅰ组（sPAP＜50 mmHg）、Ⅱ组（sPAP为50 mmHg~<70 mmHg）、Ⅲ组（sPAP≥70 mmHg），对138例疑诊CTD合并PH（CTD-PH）患者的临床资料及超声心动图资料进行总结分析。结果：①CTD-PH的发病率研究：1 729例患者中138人肺动脉压力升高（发病率8.0%），单个疾病的PH发病率分析，最高的为混合性结缔组织病（MCTD）和系统性硬化（SSc），发病率分别为30.8%和10.5%。②CTD-PH临床危险因素研究：随着PH程度的加重，肺间质纤维化、雷诺现象及高尿酸血症的发生率升高（P＜0.05）。③CTD-PH心脏超声改变的研究：肺动脉内径（PAD）、右房上下径（RAD1）、右房左右径（RAD2）、右室基底段横径（RVD1）、右室中间段横径（RVD2）、右室上下径（RVD3）及RVD1与左室基底段横径（LVD2）比值（RVD1/LVD2）随着PH程度加重逐渐增加（P＜0.05）；PH Ⅲ组同其余3组比较，左室前后径（LVD1）均减小（P＜0.05）；PH Ⅰ、Ⅱ组左房前后径（LAD）较对照组增加；PH Ⅰ组LVD1较对照组增加（P＜0.05）；Spearman相关性分析，PAD、RAD1、RAD2、RVD1、RVD2、RVD3及RVD1/LVD2与PH程度呈显著正相关（P＜0.001）；瓣膜病变情况分析，三尖瓣关闭不全发生率最高，其次为二尖瓣、主动脉瓣关闭不全，瓣膜狭窄及赘生物发生率较低。结论：CTD不同亚组合并PH发病率不同，超声心动图是CTD患者PH筛查的重要工具，CTD患者肺动脉压力升高有多种可能原因，超声心动图在诊断肺动脉压力升高的同时，通过心脏结构和功能的改变，对产生PH的原因有一定的鉴别作用。
Abstract
Objective: To investigate the incidence, clinical features and echocardiographic characteristics of connective tissue disease(CTD) associated with pulmonary hypertention(PH). Methods: The ultrasonic cardiogram data of 1 729 CTD inpatients from June 2014 to December 2016 were collected. According to sPSP≥36 mmHg(1 mmHg≈0.133 kPa), PH patients were screened out and divided into group Ⅰ(sPAP<50 mmHg), group Ⅱ(sPAP: 50 mmHg~<70 mmHg), group Ⅲ (sPAP≥70 mmHg). Clinical and echocardiographic data of 138 suspected CTD-PH were analyzed retrospectively. Results:①The incidence rate of PH in patients with CTD was about 8.0%. MCTD and SSc had the highest incidence of PH(30.8% and 10.5%). ②The incidence rate of pulmonary interstitial fibrosis, Raynaud’s phenomenon and hyperuricemia were increased with the PH degree. ③PAD, RAD1, RAD2, RVD1, RVD2, RVD3 and RVD1/LVD were increased with the PH degree(P<0.05). Compared with former three groups, group Ⅲ had lower LVD1(P<0.05). Compared with control group, group Ⅰ and group Ⅱ had higher LAD, group Ⅰ had higher LVD1(P<0.05). PAD, RAD1, RAD2, RVD1, RVD2, RVD3 and RVD1/LVD2 were positively correlated with the degree of PH(P<0.001). Tricuspid valve regurgitation had the highest incidence of PH, followed by mitral and aortic valve regurgitation. The incidence of valvular stenosis and neoplasm were low. Conclusion: The incidence of PH in subgroups of CTD were different. Echocardiography is an important tool for screening PH patients. CTD-PH have a variety of reasons, we can assess the changes of cardiac structure and functions through echocardiography to identified the reasons.
关键词
结缔组织病 /
高血压 /
肺性 /
超声心动描记术
Key words
Connective tissue diseases /
hypertension, pulmonary /
Echocardiography
中图分类号：
Ｒ593.2
Ｒ543.2
Ｒ540.45
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