目的 应用超声心动图技术研究特发性肺动脉高压(idiopathic pulmonary arterial hypertension,IPAH)患者的心脏结构及血流动力学特点,对比右心导管结果,探讨超声心动图在诊断IPAH中的临床价值.方法 选择经右心导管检查确诊的IPAH患者42例,正常对照组30例.经胸超声心动图测量左、右心室舒张末期前后径及左右径(RVT、LVT),计算左、右心室前后径及左右径的比值(RVD/LVD、RVT/LVT);测量右室前壁厚度(RVAWT)及左室后壁厚度(LVPWT),计算RVAWT/LVPWT;多普勒超声测量三尖瓣及肺动脉瓣最大反流压差等参数,并将右心导管与超声心动图的检测指标进行相关性分析.结果 本研究中女性患者最常见,男女比为1∶2.5.本组IPAH患者,肺动脉收缩压(PASP)与肺动脉平均压(PAMP)均明显增高.RVD/LVD、RVT/LVT、RVAWT/LVPWT各指标,IPAH组与正常对照组之间均有明显统计学意义.超声心动图估测肺动脉收缩压(PASPe)与右心导管检测PASPc呈显著相关,超声心动图估测PAMPe与右心导管检测者相关性良好;RVD/LVD、RVT/LVT、RVAWT/LVPWT指标中,RVAWT/LVPWT、RVT/LVT与PASPc呈明显相关,RVD/LVD与PASPc的相关性无明显统计学意义.结论 超声心动图能够准确反映IPAH患者肺动脉高压的阶段和程度,超声心动图通过准确评价心脏的结构及血流动力学特点可为诊断IPAH提供客观准确的依据.%Objective To study the characteristics of cardiac structure and hernodynamics of patients with Idio-pathic pulmonary arterial hypertension (IPAH)by echocardiography. A comparative study about the non-invasive ech-ocardiography between right-heart catheterization were performed to explore the clinical value of echocardiography in patients with IP AH. Methods 42 IP AH patients confirmed by right-heart catheterization (RHC) were enrolled in our study and a health control group was set up. The anteroposterior, transverse diameters of left and right ventricular at end diastole, the ratio of the anteroposterior diameter to the transverse diameter, the thickness ofleft ventricular posterior wall and of right ventricular anterior wall were measured by transthoracic echocardiography. Maximum differential pressure of tricuspid valves or pulmonary valve was evaluated by Doppler echocardiography. A linear correlation was performed to compare the two methods of parameters. Results In our study, the female patients were very hackneyed compared with the male patients. The PASP and The PAMP were markedly increased in IPAH groups. The parameters of echocardiography showed significant difference between the two groups. The results also showed significant correlation between the PASPe and PASPc, meanwhile the results also showed well correlation between the PAMPe and PAMPc; Of all the parameters, RVAWT/LVPWT and RVT/LVT correlated well with PASPc. Conclusions Echocardiography could accurately reflect the different phasesand degrees of PAH, this noninvasive method could provide a reliable objective evidence for the clinical diagnosis and treatment in patients with IPAH.
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