[慢性血栓栓塞性肺动脉高压球囊肺动脉血管成形术的回顾性研究]
[A retrospective study of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension].
作者信息
Ding Y, Gong J N, Wang J F, Huang Q, Liu L, Jiao X J, Wang W, Yang Y H
机构信息
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing 100020, China.
Department of Interventional Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
出版信息
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Dec 12;43(12):1049-1054. doi: 10.3760/cma.j.cn112147-20200116-00025.
To analyze the efficacy and safety of Balloon Pulmonary Angioplasty (BPA) in patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH). A total of 38 CTEPH patients received at least one BPA treatment between February 2017 and April 2019 were enrolled. World Health Organization functional class(WHO-FC), 6-minute walking distance(6WMD), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance(PVR), N-terminal pro brain natriuretic peptide(NT-proBNP) and echocardiographic indicators were collected at baseline and before each BPA procedure. 38 patients received 95 times of BPA [ 2 (1, 4) times per person] totally. MPAP was 50 (43, 56) mmHg(1 mmHg=0.133 kPa) before BPA and 41(32, 50) mmHg after at least one BPA procedure, <0.001. MPAP decreased from 50(42, 55) to 34(28, 49) mmHg (=0.003) in 17 cases after 3-5 BPA procedures. In 15 cases, PVR decreased from 852(583, 1 140)dyn·s·cm to 496(406, 802)dyn·s·cm, =0.009. Besides, there were 13 patients with WHO Function Class Ⅰ/Ⅱ before BPA, 25 patients with Ⅲ/Ⅳ class before BPA, 29 patients with Ⅰ/Ⅱ class after BPA treatment, and 9 patients with Ⅲ/Ⅳ after BPA treatment, <0.001. 6 WMD before and after BPA increased from 360(290, 442)m to 449(376, 505)m, =0.015. The Meyer score of lung perfusion scanning got improved, from 0.54(0.53, 0.58) to 0.50(0.44, 0.58), <0.001. Among all registered patients, 21 of whom NT-proBNP decreased from 1 285(606, 2 794) to 472(148, 745), =0.014. The inner diameter of the right ventricular decreased from 54(41, 54)mm before surgery to 42(34, 49)mm after surgery, <0.001. 6(6.3%, 6/95) complications occurred in 95 times of BPA. For inoperable patients with CTEPH, BPA can significantly improve disease severity, 6 MWD, heart function, decrease mPAP, PVR and improve lung perfusion, which is a safe and effective therapy.
分析球囊肺动脉血管成形术（BPA）治疗慢性血栓栓塞性肺动脉高压（CTEPH）患者的疗效及安全性。选取2017年2月至2019年4月期间共38例接受至少1次BPA治疗的CTEPH患者。收集患者基线及每次BPA治疗前的世界卫生组织功能分级（WHO-FC）、6分钟步行距离（6WMD）、平均肺动脉压（mPAP）、肺血管阻力（PVR）、N末端脑钠肽前体（NT-proBNP）及超声心动图指标。38例患者共接受95次BPA治疗[每人2（1，4）次]。BPA治疗前mPAP为50（43，56）mmHg（1 mmHg = 0.133 kPa），至少1次BPA治疗后为41（32，50）mmHg，P<0.001。17例患者经3 - 5次BPA治疗后mPAP从50（42，55）mmHg降至34（28，49）mmHg（P = 0.003）。15例患者PVR从852（583，1 140）dyn·s·cm降至496（406，802）dyn·s·cm，P = 0.009。此外，BPA治疗前WHO功能分级Ⅰ/Ⅱ级患者13例，Ⅲ/Ⅳ级患者25例；治疗后Ⅰ/Ⅱ级患者29例，Ⅲ/Ⅳ级患者9例，P<0.001。BPA治疗前后6WMD从360（290，442）m增加至449（376，505）m，P = 0.015。肺灌注扫描的迈耶评分得到改善，从0.54（0.53，0.58）降至0.50（0.44，0.58），P<0.001。所有登记患者中，21例NT-proBNP从1 285（606，2 794）降至472（148，745），P = 0.014。右心室内径术前为54（41，54）mm，术后为42（34，49）mm，P<0.001。95次BPA治疗共发生6例（6.3%，6/95）并发症。对于无法手术的CTEPH患者，BPA可显著改善疾病严重程度、6MWD、心功能，降低mPAP、PVR并改善肺灌注，是一种安全有效的治疗方法。
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