CAJ | 학술논문

目的确定超声心动图是否能非侵入性鉴别诊断肺动脉高压(PAH)和肺静脉高压(PVH).方法随机选择56例经超声心动图确定的肺动脉收缩压(PASP)≥40 mmHg的患者,并在7 d内进行心导管检查.依据左室舒张末压或肺毛细血管契压(PCWP)将患者分为PAH组30例,PVH组26例.两组患者应用常规和组织多普勒超声技术分别测定跨二尖瓣舒张早期峰值血流速度E峰,晚期A峰,E/A比值,二尖瓣血流减速时间(DT),舒张早期二尖瓣环运动速度(E')和E/E'值.结果与PVH组比较,PAH组A峰、DT、PASP及E,增大,而E峰、E/A值和E/E'值却降低.E/E'值和E/A值是PAH和PVH鉴别诊断的最佳指标,其E/E'值和E/A值的ROC曲线下面积分别为97%和91%,而诊断PVH的最佳界值点是E/E'>9.2(敏感性为95%,特异性为97%),E/A>1.7(敏感性为75%,特异性为92%).结论采用常规和组织多普勒超声技术可正确鉴别PAH和PVH.
목적 학정초성심동도시부능비침입성감별진단폐동맥고압(PAH)화폐정맥고압(PVH).방법 수궤선택56례경초성심동도학정적폐동맥수축압(PASP)≥40 mmHg적환자,병재7 d내진행심도관검사.의거좌실서장말압혹폐모세혈관계압(PCWP)장환자분위PAH조30례,PVH조26례.량조환자응용상규화조직다보륵초성기술분별측정과이첨판서장조기봉치혈류속도E봉,만기A봉,E/A비치,이첨판혈류감속시간(DT),서장조기이첨판배운동속도(E')화E/E'치.결과 여PVH조비교,PAH조A봉、DT、PASP급E,증대,이E봉、E/A치화E/E'치각강저.E/E'치화E/A치시PAH화PVH감별진단적최가지표,기E/E'치화E/A치적ROC곡선하면적분별위97%화91%,이진단PVH적최가계치점시E/E'>9.2(민감성위95%,특이성위97%),E/A>1.7(민감성위75%,특이성위92%).결론 채용상규화조직다보륵초성기술가정학감별PAH화PVH.
Objective To determine whether pulmonary arterial hypertension(PAH) and pulmonary venous hypertension (PVH) can be differentiated noninvasively by echocardiography. Methods Fifty-six patients with pulmonary arterial systolic pressure(PASP) ≥40 mmHg by echocardiography were involved,and cardiac catheterization performed within 7 days of each other. Based on left ventricular end-diastolic pressure or pulmonary capillary wedge pressure(PCWP) ,30 patients were classified as PAH group and 26 patients as PVH group. The early(E) and late(A) diastolic mitral inflow velocities,E/A ratios,deceleration time(DT),early dastlic mitrial annular velocity(E') and E/E' ratios were measured by conventional and Doppler tissue imaging echocardiography in the two groups. Results Compared with PVH group,the PAH group had significantly higher A,DT,PASP and E',and significantly lower E,E/A ratio and E/E' ratio (P < 0. 01 or P <0. 001). E/E' and E/A ratio was optimal indexes for differentiation of PAH and PVH,the area under receiver operating characteristic curve was 97% and 91 %, respectively. Optimal cutoff for diagnosing PVH was E/E'>9.2 (sensitivity 95%, specificity 97%) and E/A> 1. 7 (sensitivity 75%,specificity 92%). Conclusions PAH and PVH imaging can be reliably differentiated by echocardiography.