特发性肺动脉高压与先天性心脏病相关肺动脉高压患者右心室心肌葡萄糖代谢的比较研究

目的 比较分析特发性肺动脉高压（IPAH）与先天性心脏病相关肺动脉高压（PAH-CHD）患者右心室心肌葡萄糖代谢的差异。 方法 选取2016年11月至2018年12月在中国医学科学院北京协和医学院阜外医院确诊的26例IPAH患者（IPAH组）[女性17例、男性9例，年龄（28.23±8.92）岁] 和16例PAH-CHD患者（PAH-CHD组） [女性10例、男性6例，年龄（29.19±10.62）岁]。所有患者均行动态18F-FDG PET心肌代谢显像，根据Patlak法计算得出右心室和左心室心肌葡萄糖利用率（rMGU）。显像后1周内患者接受右心导管检查，测定血流动力学指标。采用独立样本t检验比较2组的rMGU等指标；采用Pearson相关分析对2组患者右心室的rMGU与平均肺动脉压力（mPAP）或肺血管阻力的相关性进行分析。 结果 IPAH组与PAH-CHD组患者mPAP之间的差异无统计学意义 [（59.85±16.46） mm Hg 对（69.75±18.93） mm Hg，t=1.79，P=0.81]（1 mm Hg=0.133 kPa）。动态18F-FDG PET心肌代谢显像测得的2组患者右心室rMGU[（0.095±0.074） μmol·g−1·min−1 对（0.135±0.165） μmol·g−1·min−1]与左心室rMGU[（0.057±0.065） μmol·g−1·min−1 对（0.070±0.047） μmol·g−1·min−1] 之间的差异均无统计学意义（t=1.07, P=0.29；t=0.77，P=0.49）。IPAH组患者右心室的rMGU与mPAP存在正相关（r=0.420，P=0.033），但PAH-CHD组患者右心室的rMGU与mPAP无相关性（r=0.016，P=0.953）。 结论 mPAP无差异的IPAH和 PAH-CHD患者右心室心肌葡萄糖代谢水平无明显差异。

A comparative study of right ventricular glucose metabolism between patients with idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension related to congenital heart disease

Objective To analyze the glucose metabolism of right ventricle between patients with idiopathic pulmonary arterial hypertension (IPAH) and patients with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). Methods From November 2016 to December 2018, 26 patients with IPAH (the IPAH group) (17 females, 9 males, 28.23±8.92 years old) and 16 patients with PAH-CHD (the PAH-CHD group) (10 females, 6 males, 29.19±10.62 years old) diagnosed in Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College were enrolled and underwent dynamic 18F-FDG PET myocardial metabolic imaging. The rate of myocardium glucose utilization (rMGU) of both the right and left ventricles was quantified via Patlak analysis. Within 1 week, right heart catheterization was performed in all subjects to evaluate pulmonary hemodynamic parameters. rMGU and other parameters were compared via independent sample t test. The relationship between rMGU and pulmonary vascular resistance and mean pulmonary artery pressure (mPAP) in the two groups of patients was analyzed via Pearson correlation analysis. Results No significant difference in mPAP was observed between patients in IPAH group and PAH-CHD group ((59.85±16.46) mm Hg) vs. (69.75±18.93) mm Hg, t=1.79, P=0.81) (1 mm Hg=0.133 kPa). The right ventricular rMGU of patients in PAH-CHD group was not significantly different from that of patients in IPAH group ((0.135±0.165) μmol·g−1·min−1 vs. (0.095±0.074) μmol·g−1·min−1, t=1.07, P=0.29). Similarly, the left ventricular rMGU between the former ((0.070±0.047) μmol·g−1·min−1) and the latter ((0.057±0.065) μmol·g−1·min−1) was not significantly different (t=0.77, P=0.49). The right ventricular rMGU was significantly correlated with mPAP in patients with IPAH (r=0.420, P=0.033), but not in patients with PAH-CHD (r=0.016, P=0.953). Conclusion In patients with PAH-CHD and IPAH with no difference in mPAP, no significant difference in rMGU was found in both the right ventricles.