Aminde L N, Dzudie A, Kengne A P, Ndjebet J, Mapoh S, Kuelang X, Kamdem F, Mbatchou Ngahane B H, Doualla M-S, Ngu K B, Sliwa K, Thienemann F
School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia; Cardiology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon; Clinical Research Education, Networking and Consultancy, Douala, Cameroon.
S Afr Med J. 2017 Sep 22;107(10):892-899. doi: 10.7196/SAMJ.2017.v107i10.12321.
Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting.
To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon.
A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality.
In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30).
Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.
肺动脉高压（PH）是导致心力衰竭的一个重要原因，在非洲地区对此研究较少。
研究性别对喀麦隆杜阿拉市肺动脉高压患者临床表现、超声心动图特征及预后的影响。
作为泛非肺动脉高压队列研究的一部分，于2012年3月至2013年12月进行了一项前瞻性队列研究。通过超声心动图诊断PH，定义为在无急性右心衰竭情况下右心室收缩压>35 mmHg。对患者进行最长12个月的随访，以主要终点死亡率为观察指标。
共招募了130例肺动脉高压患者；71例（54.6%）为女性。男性的中位年龄为59.2岁，女性为58.3岁（p = 0.76）。男性中主动吸烟和饮酒的比例高于女性（均p<0.001），但女性接触室内烹饪油烟的情况比男性更严重（p<0.001）。既往结核感染（11.3%对1.7%）和S3奔马律（30.9%对11.9%）在女性中更常见（均p<0.03）。与男性相比，女性的平均收缩压显著更高（134 mmHg对125 mmHg；p = 0.04）、脉压更高（53.8 mmHg对44.9 mmHg；p = 0.01），平均血红蛋白浓度更低（10.4 g/dL对12.4 g/dL；p<0.05）。男性超声心动图左心室（LV）收缩功能障碍更常见：平均左心室射血分数42.6%对51.5%（p = 0.01），平均缩短分数21.4%对28.6%（p = 0.01）。总死亡率为20.3%，两组死亡率相似（Kaplan-Meier对数秩检验χ² = 1.1；p = 0.30）。
尽管在包括心血管危险因素等基线特征方面存在差异，但本研究中男性和女性随访期间的死亡率相似。然而，这些不同的基线特征可能提示在我们研究环境中男性和女性肺动脉高压发病机制存在差异，需要进一步研究。
