中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
9期
769-773
,共5页
张浩%张海锋%孙伟%盛燕辉%杨荣%徐东杰%周芳%许莹%周艳丽
張浩%張海鋒%孫偉%盛燕輝%楊榮%徐東傑%週芳%許瑩%週豔麗
장호%장해봉%손위%성연휘%양영%서동걸%주방%허형%주염려
高血压,肺性%血液动力学现象
高血壓,肺性%血液動力學現象
고혈압,폐성%혈액동역학현상
Hypertension,pulmonary%Hemodynamic phenomena
目的 比较左心疾病相关性肺高血压的2种分类方法,即按跨肺压差(transpulmonary pressure gradient,TPG)和按肺动脉舒张压差(diastolic pressure difference,DPD)分类的血液动力学特点及二者的一致性.方法 入选33例右心导管确诊的左心疾病相关性肺高血压患者.按TPG将患者分为2组,TPG≤12 mmHg(1 mmHg =0.133 kPa)组17例和TPG＞ 12 mmHg组16例.按DPD将患者分为2组,DPD＜7 mmHg组23例,DPD≥7 mmHg组10例.检测并分别比较2种分类方法各组间患者的血液动力学指标.使用McNemar's检验比较2种分类方法的一致性.结果 按TPG分类的两组患者,即TPG≤12 mmHg组和TPG＞ 12 mmHg组,上腔静脉压分别为(9.0±2.5)mmHg和(12.7±5.4) mmHg、右心房平均压分别为(9.1±2.4)mmHg和(12.8 ±5.2) mmHg、右心室收缩压分别为(45.5±9.8)mmHg和(66.8 ±15.4) mmHg、右心室平均压分别为(22.6±5.2)mmHg和(33.1 ±7.5)mmHg、肺动脉收缩压分别为(44.2±10.3) mmHg和(64.8±14.2)mmHg、肺动脉舒张压分别为(24.2±4.5)mmHg和(33.1±8.3)mmHg、肺动脉平均压分别(32.3±5.7)mmHg和(45.8±8.6) mmHg、心指数分别为(2.6±1.0)L·min-1 ·m-2和(1.9±0.9)L·min-·m-2、右心室射血分数分别为(31.2±12.6)％和(22.6±7.1)％、肺血管阻力分别为(2.3±0.84) Wood和(6.3±2.6)Wood,上述指标2组间比较差异均有统计学意义(P均＜0.05).而按DPD分类的2组患者,即DPD＜7 mmHg组和DPD≥7 mmHg组,仅右心室舒张压[(7.4±3.7)mmHg比(11.5±5.7) mmHg]、肺动脉舒张压[(25.9±6.4) mmHg比(34.7 ±8.0) mmHg]和肺血管阻力[(3.3±2.0) Wood比(6.2±3.4) Wood],3个指标2组间差异有统计学意义(P均＜0.05).McNemar's检验结果显示2种分类方法一致性较差,κ =0.386 6(95％ CI:0.092 2～0.681 0).结论 TPG分类方法能较好地区分左心疾病相关性肺高血压的血液动力学差异,TPG分类方法与DPD分类方法的一致性较差.
目的 比較左心疾病相關性肺高血壓的2種分類方法,即按跨肺壓差(transpulmonary pressure gradient,TPG)和按肺動脈舒張壓差(diastolic pressure difference,DPD)分類的血液動力學特點及二者的一緻性.方法 入選33例右心導管確診的左心疾病相關性肺高血壓患者.按TPG將患者分為2組,TPG≤12 mmHg(1 mmHg =0.133 kPa)組17例和TPG＞ 12 mmHg組16例.按DPD將患者分為2組,DPD＜7 mmHg組23例,DPD≥7 mmHg組10例.檢測併分彆比較2種分類方法各組間患者的血液動力學指標.使用McNemar's檢驗比較2種分類方法的一緻性.結果 按TPG分類的兩組患者,即TPG≤12 mmHg組和TPG＞ 12 mmHg組,上腔靜脈壓分彆為(9.0±2.5)mmHg和(12.7±5.4) mmHg、右心房平均壓分彆為(9.1±2.4)mmHg和(12.8 ±5.2) mmHg、右心室收縮壓分彆為(45.5±9.8)mmHg和(66.8 ±15.4) mmHg、右心室平均壓分彆為(22.6±5.2)mmHg和(33.1 ±7.5)mmHg、肺動脈收縮壓分彆為(44.2±10.3) mmHg和(64.8±14.2)mmHg、肺動脈舒張壓分彆為(24.2±4.5)mmHg和(33.1±8.3)mmHg、肺動脈平均壓分彆(32.3±5.7)mmHg和(45.8±8.6) mmHg、心指數分彆為(2.6±1.0)L·min-1 ·m-2和(1.9±0.9)L·min-·m-2、右心室射血分數分彆為(31.2±12.6)％和(22.6±7.1)％、肺血管阻力分彆為(2.3±0.84) Wood和(6.3±2.6)Wood,上述指標2組間比較差異均有統計學意義(P均＜0.05).而按DPD分類的2組患者,即DPD＜7 mmHg組和DPD≥7 mmHg組,僅右心室舒張壓[(7.4±3.7)mmHg比(11.5±5.7) mmHg]、肺動脈舒張壓[(25.9±6.4) mmHg比(34.7 ±8.0) mmHg]和肺血管阻力[(3.3±2.0) Wood比(6.2±3.4) Wood],3箇指標2組間差異有統計學意義(P均＜0.05).McNemar's檢驗結果顯示2種分類方法一緻性較差,κ =0.386 6(95％ CI:0.092 2～0.681 0).結論 TPG分類方法能較好地區分左心疾病相關性肺高血壓的血液動力學差異,TPG分類方法與DPD分類方法的一緻性較差.
목적 비교좌심질병상관성폐고혈압적2충분류방법,즉안과폐압차(transpulmonary pressure gradient,TPG)화안폐동맥서장압차(diastolic pressure difference,DPD)분류적혈액동역학특점급이자적일치성.방법 입선33례우심도관학진적좌심질병상관성폐고혈압환자.안TPG장환자분위2조,TPG≤12 mmHg(1 mmHg =0.133 kPa)조17례화TPG＞ 12 mmHg조16례.안DPD장환자분위2조,DPD＜7 mmHg조23례,DPD≥7 mmHg조10례.검측병분별비교2충분류방법각조간환자적혈액동역학지표.사용McNemar's검험비교2충분류방법적일치성.결과 안TPG분류적량조환자,즉TPG≤12 mmHg조화TPG＞ 12 mmHg조,상강정맥압분별위(9.0±2.5)mmHg화(12.7±5.4) mmHg、우심방평균압분별위(9.1±2.4)mmHg화(12.8 ±5.2) mmHg、우심실수축압분별위(45.5±9.8)mmHg화(66.8 ±15.4) mmHg、우심실평균압분별위(22.6±5.2)mmHg화(33.1 ±7.5)mmHg、폐동맥수축압분별위(44.2±10.3) mmHg화(64.8±14.2)mmHg、폐동맥서장압분별위(24.2±4.5)mmHg화(33.1±8.3)mmHg、폐동맥평균압분별(32.3±5.7)mmHg화(45.8±8.6) mmHg、심지수분별위(2.6±1.0)L·min-1 ·m-2화(1.9±0.9)L·min-·m-2、우심실사혈분수분별위(31.2±12.6)％화(22.6±7.1)％、폐혈관조력분별위(2.3±0.84) Wood화(6.3±2.6)Wood,상술지표2조간비교차이균유통계학의의(P균＜0.05).이안DPD분류적2조환자,즉DPD＜7 mmHg조화DPD≥7 mmHg조,부우심실서장압[(7.4±3.7)mmHg비(11.5±5.7) mmHg]、폐동맥서장압[(25.9±6.4) mmHg비(34.7 ±8.0) mmHg]화폐혈관조력[(3.3±2.0) Wood비(6.2±3.4) Wood],3개지표2조간차이유통계학의의(P균＜0.05).McNemar's검험결과현시2충분류방법일치성교차,κ =0.386 6(95％ CI:0.092 2～0.681 0).결론 TPG분류방법능교호지구분좌심질병상관성폐고혈압적혈액동역학차이,TPG분류방법여DPD분류방법적일치성교차.
Objective To compare the features of patients with pulmonary hypertension due to left heart disease classified according to transpulmonary gradient (TGP) or diastolic pressure difference (DPD).Methods Thirty-three patients with pulmonary hypertension due to left heart disease diagnosed by right heart catheterization were enrolled.Patients were divided into two groups according to TPG:17 patients with TPG ≤ 12 mmHg(1 mmHg =0.133 kPa) and 16 patients with TPG ＞ 12 mmHg;or divided into two groups according to DPD:23 patients with DPD ＜ 7 mmHg and 10 patients with DPD ≥ 7 mmHg.McNemar's method was used to test the agreement of the two classification methods.Results Below are the patients features according to the classification by TPG:central venous pressure ((9.0 ± 2.5) vs.(12.7 ± 5.4) mmHg),mean right atria pressure ((9.1 ± 2.4) vs.(12.8 ± 5.2) mmHg),fight heart systolic pressure ((45.5 ±9.8) vs.(66.8 ± 15.4) mmHg),right heart mean pressure ((22.6 ±5.2) vs.(33.1 ±7.5) mmHg),pulmonary systolic pressure ((44.2 ± 10.3) vs.(64.8 ± 14.2) mmHg),pulmonary diastolic pressure ((24.2 ±4.5) vs.(33.1 ±8.3) mmHg),pulmonary mean pressure ((32.3 ±5.7) vs.(45.8 ± 8.6) mmHg),cardiacindex ((2.6±1.0) vs.(1.9±0.9) L· min-1 · m-2),right heart EF((31.2± 12.6)％ vs.(22.6 ±7.1) ％) and pulmonary vascular resistance ((2.3 ±0.8) vs.(6.3 ±2.6) Wood) were significantly different between the two groups (all P ＜ 0.05).According to the classification of DPD,only right heart diastolic pressure ((7.4 ± 3.7) vs.(11.5 ± 5.7) mmHg),pulmonary diastolic pressure ((25.9 ±6.4) vs.(34.7 ±8.0) mmHg) and pulmonary vascular resistance((3.3 ±2.0)vs.(6.2 ±3.4) Wood) were significantly different between the two groups (all P ＜ 0.05).These was a weak agreement (κ =0.386 6,95％ CI:0.092 2-0.681 0) between the two classification methods.Conclusion TPG classification is superior to DPD classification for pulmonary hypertension patients due to left heart disease on identifying the hemodynamic differences.
