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195例中国WHO I级肺动脉高压患者的临床特征

[Clinical characteristics of 195 Chinese patients with WHO Class I pulmonary hypertension].

作者信息

Zhang Gangcheng, Shang Xiaoke, Deng Xiaoxian, Zhou Hongmei

机构信息

Congenital Heart Diseases Center, Wuhan Asia Heart Hospital, Wuhan 430022, China. Email:

Congenital Heart Diseases Center, Wuhan Asia Heart Hospital, Wuhan 430022, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Dec;42(12):1001-5.

Abstract

OBJECTIVE

To analyze the clinical characteristics of WHO Class I pulmonary hypertension (PAH) in central China.

METHODS

Data was collected as a part of prospective registry of PAH through Jan. 2009 to Oct. 2013 in Wuhan Asia Heart Hospital. A total of 195 patients were recruited including 144 cases with congenital heart disease with pulmonary hypertension (CHD-PAH) and 51 cases with idiopathic pulmonary hypertension (IPAH).

RESULTS

The age of all patients ranged from 1 to 68 years (mean (27.5 ± 13.2) years), 129 cases were female (66.2%). WHO Class I PAH accounted for 91.1%, CHD-PAH 67.3%, IPAH 23.8%, and other 8.9%.WHO function class III/IV in newly diagnosed PAH accounted for 32.3%, the mean 6MWD was (397 ± 74) m. For patients with IPAH, the median time period between onset of symptoms and diagnosis by right heart catheterization was 38 months. The mean pulmonary pressure, pulmonary vascular resistance index, cardiac index of patients with IPAH and CHD-PAH were measured by the right heart catheterization and there was no difference between the two groups. Acute pulmonary vasodilator testing was negative in all patients in this cohort. Cardiac function was improved in the 121 cases who received the targeted drug treatment and 1 patient died out of these 121 patients while 5 cases died out of patients receiving conventional therapy.

CONCLUSION

In Central China, Class I pulmonary hypertension is the most predominant type of PAH, the cardiac function and hemodynamic indexes of these patients were significantly impaired at the time of first PAH diagnosis. Most of the patients accepted targeted drug treatment of pulmonary hypertension, but the drug dose used for the targeted drug treatment is not effective enough in these patients.

摘要

目的

分析中国中部地区世界卫生组织(WHO)I 级肺动脉高压(PAH)的临床特征。

方法

数据收集自 2009 年 1 月至 2013 年 10 月在武汉亚洲心脏病医院进行的 PAH 前瞻性注册研究。共纳入 195 例患者,其中 144 例为先天性心脏病合并肺动脉高压(CHD-PAH),51 例为特发性肺动脉高压(IPAH)。

结果

所有患者年龄在 1 至 68 岁之间(平均(27.5±13.2)岁),女性 129 例(66.2%)。WHO I 级 PAH 占 91.1%,CHD-PAH 占 67.3%,IPAH 占 23.8%,其他占 8.9%。新诊断的 PAH 患者中 WHO 功能分级 III/IV 级占 32.3%,平均 6 分钟步行距离(6MWD)为(397±74)米。对于 IPAH 患者,症状出现至右心导管检查确诊的中位时间为 38 个月。通过右心导管检查测量了 IPAH 和 CHD-PAH 患者的平均肺动脉压、肺血管阻力指数、心指数,两组之间无差异。该队列中所有患者的急性肺血管扩张试验均为阴性。121 例接受靶向药物治疗的患者心功能得到改善,这 121 例患者中有 1 例死亡,而接受传统治疗的患者中有 5 例死亡。

结论

在中国中部地区,I 级肺动脉高压是 PAH 最主要的类型,这些患者在首次诊断 PAH 时心功能和血流动力学指标明显受损。大多数患者接受了肺动脉高压的靶向药物治疗,但靶向药物治疗所用药物剂量对这些患者的疗效不足。

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