目的 探讨应用超声心动图评价肺动脉高压(PAH)致心肌损伤的临床价值及氧化应激损伤的相关性。方法 12周龄SD大鼠48只。随机均分为4组:空白对照组、NaCl对照组、PAH 2周组及PAH 4周组。建模后,采用超声检测相关参数。HE及Masson染色观察右心室的心肌细胞及胶原纤维分布情况,测定超氧化物歧化酶(SOD)活力,还原型谷胱甘肽(GSH)和丙二醛(MDA)水平,并评价其与超声参数的相关性。结果 PAH组大鼠超声相关参数均变化明显,且逐渐加重。HE及Masson染色显示心肌细胞增大,心肌间隙中的胶原纤维明显增多,且4周组较明显。PAH组大鼠心肌组织中的SOD活力及GSH水平较低,而MDA水平较高,有变化趋势,且与超声参数有显著相关性,差异均有统计学意义(P<0.05)。结论 PAH导致大鼠右心室心肌组织结构改变,同时引起氧化应激相关指标的变化。

Objective To explore the clinical value of echocardiographic evaluation of myocardial injury caused by pulmonary hypertension (PAH) and the correlation of oxidative stress injury. Methods Forty-eight 12-week-old SD rats were collected. They were randomly divided into 4 groups: blank control group, NaCl control group, PAH 2-week group and PAH 4-week group. After modeling, ultrasound was used to detect relevant parameters. HE and Masson staining were used to observe the distribution of myocardial cells and collagen fibers in the right ventricle. Superoxide dismutase (SOD) activity, reduced glutathione (GSH) and malondialdehyde (MDA) levels were measured, and their correlations with ultrasound parameters were evaluated. Results The ultrasound-related parameters of rats in the PAH group changed significantly and gradually increased.HE and Masson staining showed that cardiac myocytes were enlarged and collagen fibers in myocardial interstices were increased, and it was more obvious in the 4-week group.In the PAH group, the SOD activity and GSH levels were lower, while the MDA levels were higher, and there was a trend of change, and there was a significant correlation with ultrasound parameters. The difference was statistically significant (P<0.05). Conclusion PAH causes changes in the myocardial tissue structure of the rat right ventricle, as well as changes in oxidative stress-related indicators.

目的 分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺动脉高压(pulmonary hypertention,PH)的危险因素。方法 回顾2014年1月—2015年1月广州医科大学附属第一医院住院患者55例,经心脏彩色多普勒超声测量肺动脉收缩压(PASP),分为:轻度组(36≤PASP＜50 mmHg),中度组(51≤PASP＜70 mmHg)和重度组(PASP≥70 mmHg),分析比较三组临床特征,危险因素采用单因素及多因素Logistic回归分析。结果 年龄(75.3±11.6)岁,PASP为(52.6±15.1)mmHg。单因素分析中-重度PH与年龄、HCT、PaCO₂、PaO₂、D-二聚体有关;多因素Logistic回归分析确定3项危险因素:HCT[比值比(OR)=51.82,95% CI: 2.34～1149.02],RV(OR=4.53,95% CI: 2.83～7.27),及PaCO₂(OR=1.02,95% CI: 1.00～1.03)。结论 呼吸病相关PH多为轻-中度,高水平的HCT、RV直径及PaCO₂提示PH病情较重。

Objective To analyze the clinical risk factors of pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease(COPD). Methods A total of 55 hospitalized patients from 2014 to 2015 were enrolled in the study and were classified into three groups according to pulmonary artery systolic pressure (PASP) with echocardiography as follows: the mild group (36≤PASP＜50 mmHg), the moderate group (51≤PASP＜70 mmHg) and the severe group (PASP≥70 mmHg). Clinical data were recorded and retrospectively analyzed. Results The average age of all patients was (75.3±11.6)years. Echocardiography showed a mean PASP was 52.6±15.1 mmHg. Age, hematocrit (HCT), partial pressure of carbon dioxide (PaCO₂), the oxygen partial pressure (PaO₂), D-dimer and right ventricular (RV) diameter (>20 mm) were associated with moderate-to-severe PH on an univariate regression analysis, while RV (diameter >20 mm)[odds ratio (OR)=4.53, 95% CI: 2.83～7.27], HCT(OR=51.82, 95% CI: 2.34~1149.02) and PaCO₂ (OR=1.02, 95% CI: 1.00-1.03), to these patients, were independent risk factors using the multiple logistic regression analysis. Conclusion PH related to respiratory diseases is mostly mild-to-moderate. Haemoptysis,high levels of RV diameter, HCT and PaCO₂ suggest a serious condition of patients with PH related to chronic respiratory disease.

肺动脉高压是一类发病率低,但常引起右心衰竭等最终导致患者死亡的严重肺血管疾病,其形成的主要病理改变是肺血管重构和肺血管收缩,多种细胞因子异常作用参与发病,对该作用机制的研究成为了治疗疾病,改善疾病预后的关键。

Pulmonary hypertension is a kind of low incidence, but it is often caused by right heart failure and other serious pulmonary vascular disease. The main pathological changes of pulmonary vascular include remodeling and pulmonary vascular contraction, and many kinds of cytokines are involved in the pathogenesis of disease, which is the key to improve the prognosis of the disease.

目的 分析肺动脉栓塞超声心动图表现,探讨超声心动图估测肺动脉高压对肺动脉栓塞的诊断意义。方法 回顾性分析确诊肺动脉栓塞患者的超声心动图影像表现,就超声诊断征象进行对比分析。结果 累及肺动脉主干、两侧肺动脉近端的肺动脉栓塞检出率92.31%。肺动脉栓塞患者肺动脉高压检出率达78.38%。结论 经胸超声心动图估测肺动脉收缩压具有重要的诊断提示意义。

Objective To analyze the doppler echocardiography in the cases of pulmonary embolism and evaluate the relationship between pulmonary hypertension and pulmonary embolism. Methods To retrospectively analyze the echocardiography findings of the pulmonary hypertension. The causes of disease were classification analyzed. Results The detection rate of the embolus in the main pulmonary trunk and proximal pulmonary arteries is 92.31%. The detection rate of the pulmonary hypertension is 78.38%. Conclusion The estimation of pulmonary artery pressure in the echocardiography is helpful to diagnosis.