Correlation between the characteristics of right ventricular remodeling and therapeutic response in patients with pulmonary hypertension
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摘要:
目的 探究肺动脉高压患者右心室重构特征与治疗反应性的关联，为更准确评估患者预后提供一定思路。 方法 以2020年4月—2024年4月就诊于新疆医科大学第一附属医院的102例肺动脉高压患者作为研究对象，根据患者治疗反应性分为有反应组(79例)和无反应组(23例)。比较2组患者一般临床资料、治疗前右心导管检查参数、超声心动图参数及心肺功能的差异。通过Spearman分析及logistic回归分析筛选出肺动脉高压患者治疗无反应的危险因素。 结果 无反应组患者中合并高血压比例、平均肺动脉收缩压(PASP)、肺血管阻力(PVR)、跨肺壁压(TPG)、收缩末期右心室与左心室前后径比值(RVADs/LVADs)、舒张末期右心室与左心室左右径比值(RVTDd/LVTDd)、收缩末期右心室与左心室左右径比值(RVTDs/LVTDs)、右心室舒张末期容积(3DRVEDV)、Brog呼吸困难评分均显著高于有反应组患者(P < 0.05)；Spearman相关性分析及logistic回归分析表明PVR、TPG、RVADs/LVADs、3DRVEDV均是肺动脉高压患者治疗无反应的影响因素(OR=4.716、2.083、6.379、1.721，均P < 0.05)。 结论 肺动脉高压患者的右心室重构严重程度与患者治疗后无反应存在显著相关性，及时进行右心导管检查及超声心动图检查对于评估肺动脉高压患者治疗预后具有重要的临床意义。 Abstract:Objective Exploring the relationship between right ventricular remodeling characteristics and treatment responsiveness in patients with pulmonary arterial hypertension(PAH), providing insights for a more accurate assessment of patient prognosis. Methods A total of 102 PAH patients who visited the First Affiliated Hospital of Xinjiang Medical University from April 2020 to April 2024 were enrolled in this study. According to their treatment responsiveness, they were divided into a responsive group (n=79) and a non-responsive group (n=23). The differences in general clinical data, right-heart catheterization parameters before treatment, echocardiogram parameters, and cardiopulmonary function between the two groups were compared. Spearman analysis and logistic regression analysis were performed to screen out the risk factors for non-responsiveness to treatment in PAH patients. Results The proportion of patients with hypertension, mean pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), transpulmonary gradient (TPG), the ratio of right-ventricular anterior-posterior diameter to left-ventricular anterior-posterior diameter at end-systole (RVADs/LVADs), the ratio of right-ventricular transverse diameter to left-ventricular transverse diameter at end-diastole (RVTDd/LVTDd), the ratio of right-ventricular transverse diameter to left-ventricular transverse diameter at end-systole (RVTDs/LVTDs), right-ventricular end-diastolic volume (3DRVEDV), and the Brog dyspnea score in the non-responsive group were significantly higher than those in the responsive group (P < 0.05). Spearman correlation analysis and logistic regression analysis showed that PVR, TPG, RVADs/LVADs, and 3DRVEDV were all important risk factors for non-responsiveness to treatment in PAH patients (OR=4.716, 2.083, 6.379, 1.721, all P < 0.05). Conclusion There is a significant correlation between the severity of right ventricular remodeling and non-responsiveness to treatment in PAH patients. Timely right-heart catheterization and echocardiogram have great clinical significance for evaluating the treatment prognosis of PAH patients. -
表 1 2组肺动脉高压患者一般临床资料比较
Table 1. Comparison of general clinical data between the two groups of patients with pulmonary hypertension
组别 例数 年龄
[M(P25, P75)，岁]性别[例(%)] 体重指数
[M(P25, P75)]病程
[M(P25, P75)，年]合并高血压
[例(%)]合并糖尿病
[例(%)]合并高脂血症
[例(%)]男性 女性 有反应组 79 62(57, 65) 57(72.15) 22(27.85) 23.46(22.81, 24.11) 2(2, 3) 15(18.99) 23(29.11) 21(26.58) 无反应组 23 62(58, 68) 16(69.57) 7(30.43) 23.12(22.70, 23.96) 2(1, 3) 10(43.48) 9(39.13) 8(34.78) 统计量 0.882a 0.059b 1.065a 1.501a 5.775b 0.830b 0.589b P值 0.378 0.809 0.287 0.133 0.016 0.362 0.443 注：a为Z值，b为χ2值。 
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表 2 2组肺动脉高压患者右心导管检查参数比较(x±s)
Table 2. Comparison of right heart catheterization parameters between the two groups of patients with pulmonary hypertension(x±s)
组别 例数 PASP
(mmHg)mPAP
(mmHg)PCWP
(mmHg)PVR
(Wood)TPG
(mmHg)有反应组 79 44.99±3.03 33.62±2.50 12.96±1.62 3.33±0.64 10.53±1.52 无反应组 23 48.39±3.61 33.74±2.07 12.43±1.95 3.89±0.84 12.26±1.45 t值 4.533 0.208 1.310 3.431 4.854 P值 < 0.001 0.836 0.193 0.001 < 0.001
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表 3 2组肺动脉高压患者超声心动图参数比较(x±s)
Table 3. Comparison of echocardiographic parameters between the two groups of patients with pulmonary hypertension(x±s)
组别 例数 RVADs/LVADs RVTDd/LVTDd RVTDs/LVTDs 3DRVEDV(mL) 有反应组 79 2.01±0.11 1.49±0.13 1.46±0.15 84.31±10.12 无反应组 23 2.16±0.29 1.67±0.26 1.59±0.13 92.19±5.64 t值 3.590 4.460 3.826 3.568 P值 0.001 < 0.001 < 0.001 0.001
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表 4 2组肺动脉高压患者心肺功能比较
Table 4. Comparison of cardiopulmonary function between the two groups of patients with pulmonary hypertension
组别 例数 6MWT分级[例(%)] Brog呼吸困难评分
[M(P25, P75)，分]Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 有反应组 79 4(5.06) 17(21.52) 37(46.84) 21(26.58) 3(2，3) 无反应组 23 2(8.70) 4(17.39) 11(47.83) 6(26.09) 4(3，4) Z值 0.552 5.573 P值 0.907 < 0.001
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表 5 组间差异性指标与肺动脉高压患者治疗无反应的相关性
Table 5. Correlation between the difference indicators between groups and non-response to treatment in patients with pulmonary hypertension
指标 r值 P值 高血压 0.238 0.016 PASP 0.389 < 0.001 PVR 0.308 0.002 TPG 0.423 < 0.001 RVADs/LVADs 0.363 < 0.001 RVTDd/LVTDd 0.440 < 0.001 RVTDs/LVTDs 0.385 < 0.001 3DRVEDV 0.365 < 0.001 Brog呼吸困难评分 0.554 < 0.001
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表 6 肺动脉高压患者治疗无反应的多因素logistic回归分析
Table 6. Multivariate logistic regression analysis of nonresponse to treatment in patients with pulmonary hypertension
观察指标 B SE Waldχ2 P值 OR值 95% CI 高血压 0.649 0.425 0.240 0.624 1.913 0.832~4.402 PASP 0.121 0.193 0.389 0.533 1.128 0.772~1.648 PVR 1.551 0.737 4.432 0.019 4.716 1.112~19.996 TPG 0.734 0.369 3.964 0.031 2.083 1.011~4.294 RVADs/LVADs 1.853 0.697 7.074 0.008 6.379 1.627~25.006 RVTDd/LVTDd 2.567 3.492 0.540 0.462 13.027 0.014~1 225.999 RVTDs/LVTDs 8.638 4.686 3.397 0.065 5 642.034 0.579~54 984 396.338 3DRVEDV 0.543 0.276 3.871 0.041 1.721 1.002~2.956 Brog呼吸困难评分 3.476 2.317 2.251 0.288 32.330 0.345~3 033.038
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