本文選題：先天性心臟病 + 肺動脈高壓��； 參考：《中華高血壓雜志》2017年08期

【摘要】：目的探討超聲心動圖聯(lián)合心電圖對左向右分流型先天性心臟病相關(guān)性肺動脈高壓(PAH-CHD)的預測價值。方法收集2008年1月至2015年8月期間在福建醫(yī)科大學附屬第一醫(yī)院、協(xié)和醫(yī)院及福建省立醫(yī)院就診的左向右分流型先天性心臟病(CHD)患者共233例,其中合并肺動脈高壓(PAH)患者110例(PAH組),不合并PAH患者123例(非PAH組)。所有患者均行右心導管,參照2015年歐洲肺高壓指南以肺動脈平均壓(PAMP)≥25mm Hg作為診斷肺高壓的依據(jù)。對比兩組間超聲心動圖及心電圖指標的差異,分析超聲心動圖、心電圖指標預測PAH-CHD的準確性。結(jié)果與非PAH組相比,PAH組超聲心動圖測量的肺動脈收縮壓(PASP_(echo))、右心房橫徑(RAd)、左心室舒張末期內(nèi)徑(LVDd)、左心室舒張末期內(nèi)徑與右心室橫徑之比(LVDd/RVd)、心電圖S_(V1)振幅、R_(V5)振幅、R_(V5)+S_(V1)振幅絕對值、R_(V1)振幅乘時限、S_(V1)振幅乘時限、R_(V5)振幅乘時限增高或增大(均P0.05)。二元逐步Logistic回歸分析結(jié)果顯示PASP_(echo)、LVDd/RVd、R_(V5)振幅與時限乘積是右心導管測量的肺動脈平均壓(PAMP_(rhc))的預測指標,超聲心動圖聯(lián)合心電圖預測PAH的聯(lián)合指標(EE)=1/[1+e~(-(-6.289+0.086×PASP_(echo)+1.084×LVDd/RVd+0.006×R_(V5)振幅乘時限))]。EE和PASP_(echo)與右心導管測量的PAMP_(rhc)、肺動脈收縮壓(PASP_(rhc))、肺動脈舒張壓(PADP_(rhc))均顯著相關(guān)。且EE與PAMP_(rhc)、PASP_(rhc)、PADP_(rhc)的相關(guān)性高于PASP_(echo)與此三者的相關(guān)性(相關(guān)系數(shù)分別為0.724比0.588、0.622比0.615、0.625比0.519,均P0.05)。與PASP_(echo)相比,EE預測PAH-CHD敏感度較高(75.0%比73.6%),特異度也較高(79.3%比75.6%)。結(jié)論超聲心動圖聯(lián)合心電圖可提高對左向右分流型PAH-CHD的預測價值,敏感度為75.0%,特異度為79.3%。
[Abstract]:Objective to investigate the predictive value of echocardiography combined with electrocardiogram on left to right shunt congenital heart disease associated pulmonary hypertension (PAH-CHD). Methods to collect left to right shunt congenital heart disease (CHD) in the First Affiliated Hospital of Fujian Medical University, Concorde hospital and Fujian Province-owned Hospital from January 2008 to August 2015. A total of 233 cases, of which 110 cases (group PAH) were combined with pulmonary arterial hypertension (PAH), and 123 cases (non PAH) were not combined with PAH patients. All patients underwent right cardiac catheterization. According to the European pulmonary hypertension guidelines in 2015, the average pressure of pulmonary artery (PAMP) > 25mm Hg was used as the basis for the diagnosis of pulmonary hypertension. The differences between the two groups of echocardiography and electrocardiogram were compared. The accuracy of PAH-CHD was predicted by echocardiography and electrocardiogram. Results compared with the non PAH group, the pulmonary systolic pressure (PASP_ (echo)), the right atrium transverse diameter (RAd), the left ventricular end diastolic diameter (LVDd), the ratio of the left ventricular end diastolic diameter to the right ventricular transverse diameter (LVDd/RVd), the amplitude of S_ (V1), R_ (V5) amplitude, and the amplitude of R_ (V5) were compared in group PAH (RAd). V5) +S_ (V1) amplitude absolute value, R_ (V1) amplitude multiplicative time limit, S_ (V1) amplitude multiplicative time limit, R_ (V5) amplitude multiplicative time limit or increase (P0.05). Two element stepwise Logistic regression analysis shows that the amplitude and time product is the prediction index of the mean pulmonary artery pressure measured by the right heart catheter. PAH (EE) =1/[1+e~ (- (-6.289+0.086 * PASP_ (echo) +1.084 x LVDd/RVd+0.006 x R_ (V5) amplitude multiplicative time limit) is predicted by electrocardiogram. The correlation was higher than the correlation between PASP_ (echo) and the three (the correlation coefficient was 0.724 to 0.588,0.622 compared to 0.615,0.625, P0.05). Compared with PASP_ (echo), EE predicted PAH-CHD sensitivity (75% to 73.6%) and higher specificity (79.3% than 75.6%). Conclusion echocardiographic combined electrocardiogram can improve left to right shunt PAH-CHD. The predictive value is 75%, and the specificity is 79.3%.
【作者單位】： 福建醫(yī)科大學附屬第一醫(yī)院干部病房福建省高血壓研究所;廈門市第五醫(yī)院;
【分類號】：R541.1

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