先天性心脏病所致肺动脉高压患者肝中静脉血流频谱变化特征

目的分析先天性心脏病所致肺动脉高压（PH）患者肝中静脉多普勒血流频谱变化规律，寻找超声无创评价肺动脉高压的新指标。 方法收集第四军医大学唐都医院及沈阳军区总医院2012年1月至2013年6月来院诊治的房间隔缺损、室间隔缺损、动脉导管未闭等拟行封堵术的先天性心脏病患者80例，经右心导管测量肺动脉压力，按照不同肺动脉压力分为健康对照组、轻度PH组、中度PH组、重度PH组，采用超声检测肝中静脉血流频谱，测量心房收缩期离心波峰值血流速度（AR）、收缩期回心波峰值血流速度（S）、舒张期回心波峰值血流速度（D）和速度时间积分（VTI）。 结果健康对照组28例、轻度PH组9例、中度PH组10例、重度PH组22例，各组组间收缩期离心波血流速度时间积分（ARVTI）、收缩期回心波血流速度时间积分（SVTI）、舒张期回心波血流速度时间积分（DVTI）、AR、AR/S、ARVTI/SVTI、AR/（S＋D）、ARVTI/（SVTI＋DVTI）的差异具有统计学意义（F=2.940、2.838、3.373、7.681、3.478、12.052、4.806，P<0.05、<0.05、<0.05、<0.01、<0.05、<0.01、<0.01）。相关分析结果显示AR/（S＋D）比值与肺动脉平均压具有正相关关系（r=0.575，P<0.01）。 结论先天性心脏病患者肝中静脉频谱参数中AR/（S＋D）比值随肺动脉压力的升高而增大，具有相关性。肝中静脉血流频谱的超声探测对肺动脉高压的诊断具有一定参考价值，AR/（S＋D）比值可作为无创评价肺动脉高压的新指标。

Changes features of middle hepatic vein flow velocity waveform in patients with pulmonary hypertension caused by congenital heart disease

ObjectiveTo analyze the Doppler flow spectra of middle hepatic vein (MHV) in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD), and to explore a new non-invasive method for evaluating PH by echocardiography. MethodsAtrial septal defect, ventricular septal defect, patent patent ductus arteriosus and other 80 patients with congenital heart disease were collected from Fourth Military Medical University, Tangdu Hospital and General Hospital of Shenyang Military Area Command between January 2012 and June 2013. The pulmonary artery pressure was measured by right heart catheterization. The patients were divided into healthy control group, mild PH group, moderate PH group and severe PH group according to different pulmonary artery pressure. The peak velocities and velocity time integral (VTI) of the atrial reversal wave (AR), ventricular systolic wave (S), ventriclar diastolic wave (D) were measured at the end of inspiratory. ResultsThe differences of following parameters were statistically significant between the healthy control group, mild PH group, moderate PH group and severe PH group: velocity time integral of ventricular systolic wave (SVTI), velocity time integral of ventricular diastolic wave (DVTI), AR, AR/S, ARVTI/SVTI, AR/(S+ D), ARVTI/(SVTI+ DVTI, F=2.940, 2.838, 3.373, 7.681, 3.478, 12.052, 4.806; P<0.05, <0.05, <0.05, <0.01, <0.05, <0.01, <0.01). Correlation analysis showed that ratio of AR/(S+ D) was positively correlated with pulmonary artery mean pressure (r?=?0.575, P<0.01). ConclusionsThe ratio of AR/(S+ D) of MHV Doppler flow spectra was correlated with pulmonary artery mean pressure. The ratio increased along with the increasing of pulmonary pressure in CHD patient. The Doppler echocardiographic detection of MHV flow had a certain reference value for the diagnosis of PH. The ratio of AR/(S+ D) could be a new non-invasive parameter for evaluating PH.