目的: 探讨与左心疾病相关性肺动脉高压(PH-LHD)预后相关的危险因素。方法: 纳入2020年9月至2021年2月于包头医学院第一附属医院和包头医学院第二附属医院心内科符合入排标准的132例PH-LHD患者并平均随访12个月,收集所有患者的人口学资料、生化指标、超声心动图相关参数等以及临床事件,主要事件为全因死亡。采用单因素和多因素COX比例风险回归模型,筛选与左心相关性肺动脉高压患者预后相关的危险因素,通过Kaplan-Meier生存曲线分析肺动脉收缩压(PASP)与肺动脉高压患者预后的关系。结果: 共纳入132例PH-LHD患者,其中109例(82.6%)患者完成随访,平均随访了12(8.1,15.9)个月,共有31例患者死亡。单因素COX回归分析表明年龄、PASP、左心室舒张末期内径(LVDD)、右心室内径(RVD)、肺动脉流速、血红蛋白、超敏-C反应蛋白(hs-CRP)、谷草转氨酶(AST)、血糖(GLU)、PT、INR、甘油三酯(TG)、游离甲状腺素(FT4)是PH-LHD患者预后的危险因素(P均＜0.05)。多因素COX回归分析表明年龄、LVDD、RVD、Hb、hs-CRP、PASP(P均＜0.01)和GLU(P＜0.05)是PH-LHD患者预后的独立危险因素。Kaplan-Meier生存曲线表明,PASP＞52 mmHg的患者全因死亡的发生率较PASP≤52 mmHg患者高(P＜0.01)。结论: 年龄、LVDD、RVD、Hb、hs-CRP、GLU、PASP是与左心疾病相关肺动脉高压患者发生全因死亡相关的独立危险因素,PASP＞52 mmHg的患者全因死亡的发生率较PASP≤52 mmHg患者高。
Objective: To investigate the risk factors associated with the prognosis of pulmonary hypertension associated with left heart disease (PH-LHD). Methods: From September 2020 to February 2021,132 patients with PH-LHD who met the inclusion and exclusion criteria in the Department of Cardiology, the First Affiliated Hospital of Baotou Medical College and the Second Affiliated Hospital of Baotou Medical College were included and followed up for an average of 12 months. Demographic data, biochemical indicators, echocardiographic parameters, and clinical events of all patients were collected. The main event was all-cause mortality. Univariate and multivariate COX proportional hazard regression models were used to screen the risk factors related to the prognosis of patients with left heart-related pulmonary hypertension. The relationship between PASP and the prognosis of patients with pulmonary hypertension was analyzed by Kaplan-Meier survival curve. Results: A total of 132 patients with PH-LHD were included, of which 109 (82.6%) patients completed the follow-up, with an average follow-up of 12 (8.1, 15.9) months, and a total of 31 patients died. Univariate COX regression analysis showed that age, pulmonary artery systolic pressure (PASP), left ventricular end-diastolic diameter (LVDD), right ventricular diameter (RVD), pulmonary artery flow rate, hemoglobin, high-sensitivity C-reactive protein (hs-CRP), aspartate aminotransferase (AST), blood glucose (GLU), PT, INR, triglyceride (TG), and free thyroxine (FT4) were risk factors for prognosis in patients with PH-LHD (all P＜0.05). Multivariate COX regression analysis showed that age, LVDD, RVD, Hb, hs-CRP, PASP (P＜0.01) and GLU (P＜0.05) were independent risk factors for the prognosis of PH-LHD patients. Kaplan-Meier survival curve showed that the incidence of all-cause death in patients with PASP >52 mmHg was higher than that in patients with PASP ≤52 mmHg (P＜0.01). Conclusion: Age, LVDD, RVD, Hb, hs-CRP, GLU and PASP are independent risk factors for all-cause mortality in patients with pulmonary hypertension associated with left heart disease. The incidence of all-cause mortality in patients with PASP >52 mmHg is higher than that in patients with PASP ≤52 mmHg.
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