60岁以上老年人肺动脉高压病因学研究

目的 回顾性分析老年人肺动脉高压（pulmonary hypertension,PH）的病因,以改善PH的综合管理.方法 回顾性分析2012年1月-2014年1月在上海长海医院就诊住院的年龄大于60岁的患者,超声心动图检查提示肺动脉高压者,按病因分组进行统计,对不同疾病导致的经超声心动图三尖瓣返流速度估测的肺动脉收缩压进行比较分析.结果 资料完整的60岁以上PH病例数共540例,男278例,女262例,平均年龄（74.2±8.4）岁,中位年龄70岁.其中无特发性PAH=PH,均为疾病相关性,其中心源性共287例（扩心病19例,肥厚性心肌病8例）;先心病共27例.肺脏疾病相关性PAH为31例.瓣膜疾病相关性PAH、先心病相关性PAH及结缔组织相关性PAH=PH肺动脉收缩压明显高于心肌病及高血压引起的PAH=PH.按欧洲心脏协会2009年分类标准中属于第一组动脉型肺动脉高压为30例,占5％,左心疾病相关性PH为351例,占65％;第三组为肺疾病或/和缺氧相关性PH,为31例,占6％.其中第一组患者的肺动脉收缩压明显高于其他组.按照肺动脉收缩压升高程度来分,主要为中度升高.结论老年人PAH=PH主要是疾病相关性,最主要导致PH的疾病是左心疾病相关性.

Etiology study of patients older than 65 years old who had pulmonary hypertension

Objectice To investigate the etiology of pulmonary hypertension （PH） in patients more than 60 years old. Materials and Methods Patients who were aged 60 years old and had PH screened with echocardiography andadmitted to Changhai hospital during January 2012 to January 2014 were retrospectively analyzed. All cases were classified by possible causes induced by underlying diseases. The Parameters including sex, age, underlying diseases, systolic pressure, inner diameters of pulmonary artery, etc. were documented according to the medical records by researchers. Results All complete data of PH were from 540 patients （the gender ratio of Male to Female was 278 to 262）, with average age 74.2 years old, median age of 70. These PH patients all were diseases associated with no idiopathic pulmonary arterial hypertension. Most of them had left-heart diseases （287 patients, 53.1%）, Others were lung disease associated PH （31 cases） and chronic thrombotic and/or embolic disease associated PH （5 cases）. The average level of systolic pressure of pulmonary artery in congenital heart disease, connective tissue diseases and valvular diseases was higher than that in cardiomyopathy and hypertension associated PH. After classification of these causes according to the guideline of European Society of cardiology （ESC）, the data showed 30 patients （5.6%） belonged to group 1 of all these patients and 351 patients （65.0%） fitted group 2, 31 patients （6.0%） group 3. The average level of group 1 was higher than that in other groups. Assuming 30-40 mmHg of PH as mild PH, 40-70 mmHg of PH as moderate PH, higher than 70 mmHg as severe PH, most of these patients were classified as moderate group. Conclusion PH of patients older than 60 years old were mostly diseases associated, in which left heart diseases is the major determinant.