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藏族先天性心脏病合并肺动脉高压影响因素分析 被引量:2

Risk factors of pulmonary arterial hypertension in Tibetan patients with congenital heart disease
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摘要 目的了解高原低氧对藏族先天性心脏病(CHD)并发肺动脉高压(PAH)的影响。方法选取2007年1月-2009年12月CHD住院藏族患者220例,采用超声心动图估测肺动脉压,分析CHD合并PAH发生率以及性别、居住海拔高度对病种分布的影响;采用二分类logistic回归分析不同病种形成PAH的危险因素。结果 220例CHD患者中,合并PAH为115例,占52.27%,其中房间隔缺损(ASD)合并PAH为64例,占64.65%,高于动脉导管未闭(PDA)合并PAH32例,占41.56%;χ2=9.312,P〈0.005)及室间隔缺损(VSD)合并PAH(19例,占43.18%;χ2=5.763,P〈0.05);VSD合并PAH患者的肺动脉收缩压(sPAP)高于PDA合并PAH患者及ASD合并PAH患者(F=15.751,P〈0.05);海拔〉3 000 m ASD合并PAH的发生率高于其他2种先天性心脏缺损(F=10.79,P〈0.05),但sPAP低于PDA合并PAH患者(t=8.45,P〈0.05)及VSD合并PAH患者(t=24.26,P〈0.05);PDA和VSD患者合并PAH主要影响因素为缺损大小(OR=1.153,P〈0.05),而ASD患者合并PAH的影响因素为年龄(OR=1.31,P〈0.05)、缺损大小(OR=1.15,P〈0.05)及海拔(OR=2.75,P〈0.05)。结论高原地区CHD合并PAH的发生率远高于国内外报道;高原低氧对ASD患者合并PAH的影响较大。 Objective To explore the risk factors of the complication of pulmonary arterial hypertension(PAH) among Tibetan patients with congenital heart disease(CHD) at high altitude.Methods We retrospectively analyzed the composition of 115 PAH patients who were identified from 220 Tibetan CHD inpatients in Qinghai Cardiovascular Hospital during Jan 2007 to Dec 2009 and analyze the risk factor of PAH in different type of CHD.Results Among the 220 CHD patients,115(52.27%) had PAH.PAH was found in 64.65% of atrial septal defect(ASD),which was significantly both higher than 41.56% of the patients with ductus arteriosus(PDA)(χ2=9.312,P〈0.005)and 43.18% of ventricular septal defects(VSD)(χ2=5.763,P〈0.05).In all CHD-PAH patients,systolic pulmonary arterial pressure(sPAP) of the VSD-PAH group was significantly higher than that of other two groups(F=15.751,P〈0.05).In the patients living at the altitude 3 000 m,the incidence of ASD-PAH was higher than that of the other patients(F=10.79,P〈0.05).However,the sPAP of the ASD-PAH group was lower than that of the PDA-PAH group(t=8.45,P〈0.05)and VSD-PAH group(t=24.26,P〈0.05).Age(odds ratio(OR)= 1.31,P〈0.05),abnormal cardiac channel size(OR=1.15,P〈0.05),and altitude(OR=2.75,P〈0.05) were positively associated with an unfavorable outcome in ASD patients.Meanwhile,abnormal cardiac channel size was the only positive factor in PDA and VSD patients(OR=1.15-1.82,P〈0.05).Conclusion The incidence of CHD-PAH among Tibetan liveng in high altitude areas was 52.27%,which was obviously higher than the ones reported in the world.Hypoxia at high altitude is an important factor for development of PAH in ASD patients.
作者 祁生贵 祁国荣 陈秋红 陆霖 杨蕾 李莉 QI Sheng-gui,QI Guo-rong,CHEN Qiu-hong,et al.(Center Laboratory,Qinghai Cardio-Cerebrovascular Disease Hospital(Xi'ning 810012,China)
出处 《中国公共卫生》 CAS CSCD 北大核心 2012年第4期 466-468,共3页 Chinese Journal of Public Health
关键词 先天性心脏病 肺动脉高压 低氧 影响因素 congenital heart defect pulmonary arterial hypertension hypoxia influencing factor
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