缺氧对慢性肺心病患者甲状腺功能的影响

<正>肺心病患者由于合并不同程度的低氧血症,常导致体内激素合成和代谢发生紊乱。而肺心病作为非甲状腺疾病引起甲状腺水平异常越来越受到重视。本研究观察慢性肺心病合并甲状腺功能异常患者通过雾化吸入普米克及沙丁胺醇治疗缺氧改善后甲状腺功能的变化。1资料与方法1.1一般资料:选择2013年1月至2015年3月于我院住院治疗的慢性肺心病急性发作期患者80例,其中男52例,女28例,年龄48~85,平均(65.22±     

缺氧对慢性肺心病患者甲状腺功能的影响

目的　探讨缺氧对慢性肺心病急性发作期患者甲状腺功能的影响。方法　对 83例不同缺氧程度的慢性肺心病患者血清TT3、TT4和TSH进行检测 ,观察TT3、TT4和TSH的变化 ,并分析慢性肺心病患者Pa(O2 )与TT3、TT4和TSH的相关关系。结果　血清TT3、TT4和TSH轻度缺氧组患者分别为 ( 0 71± 0 16) μg/L、( 62 6± 12 3 ) μg/L、( 4 4± 0 8)mU/L ;中度缺氧组分别为 ( 0 4 9± 0 13 ) μg/L、( 3 3 2± 8 5 ) μg/L、( 5 3± 0 7)mU/L ;重度缺氧组分别为 ( 0 2 4± 0 0 7) μg/L、( 18 4± 4 5 ) μg/L、( 13 1± 1 2 )mU/L ;对照组分别为 ( 0 91±0 3 6) μg/L、( 84 1± 15 6) μg/L、( 3 7± 0 6)mU/L。肺心病患者 Pa(O2 )与TT3、TT4呈显著性正相关 ,与TSH呈显著性负相关 ,r分别为 0 5 671、0 5 3 4 6和 - 0 4 93 5 ,P <0 0 5。结论　缺氧是导致慢性肺心病患者甲状腺激素变化的重要因素之一 ,肺心病患者甲状腺功能减退是继发、短暂和可逆的     

不同右室-肺动脉耦合方法评估肺动脉高压患者右心室功能

目的 比较单次心跳法,结合心脏核磁共振（Cardiac Magnetic Resonance imaging, CMR）技术的容积法以及压力-容积环法这三种不同的方法测得肺动脉高压患者Ees/Ea比值的准确性,为临床找到一个切实有效定量评估肺动脉患者右心室功能的方法。方法 回顾性纳入2015年5月~2017年5月期间在武汉亚洲心脏病医院诊疗的49名肺动脉高压患者,分别用单次心跳法,结合CMR技术的容积法以及压力-容积环法测得Ees/Ea比值,再与NYHA心功能分级及NP-proBNP值比较,评估三种方法定量评价右心功能的准确性。结果 ⑴单次心跳法测量的Ees / Ea为2.07&amp;amp;#177;1.01,与NYHA心功能分级及NT-proBNP相关性分析均无统计学意义（p&amp;amp;gt;0.05）。⑵压力容积环法测得的Ees / Ea为2.64&amp;amp;#177;1.48,与NYHA心功能分级及NT-proBNP相关性分析均无统计学意义（p&amp;amp;gt;0.05）。⑶结合CMR技术的容积法测得的Ees / Ea为0.72&amp;amp;#177;0.43。与NYHA心功能分级及NT-proBNP相关性分析均具有统计学意义（p&amp;amp;lt;0.05）,均呈负相关,即随着NT-proBNP的增高,Ees / Ea随之降低;随着NYHA心功能分级的递增Ees / Ea也随之降低。⑷结合CMR技术的容积法Ees/Ea与log(NT-proBNP)之间建立了线性回归方程：Y=-0.257X+1.45,且回归方程具有统计学意义(P=0.001)。结论 结合CMR技术的容积法获得的右室-肺动脉耦合（Ees/ Ea）是一种具有临床可靠且无创的定量评估肺动脉高压患者心功能的可行性方法。     

银杏叶片对慢性肺心病肺动脉高压影响的临床观察

目的 :为探讨银杏叶片对慢性肺心病患者肺动脉高压的影响。方法 :将 42例缓解期肺心病患者分为两组 ,治疗组 2 7例 ,口服银杏叶片 ,每日 3次 ,每次 2片 (80mg) ,对照组 15例 ,口服安慰剂 ,每日 3次 ,每次 2片 ,两组病例分别于治疗前、治疗第 2 0天和第 40天时分别作心脏彩超 1次 ,测三尖瓣区血液返流速度 (Vt)计算出收缩期肺动脉压 (SPAP)。结果 :统计学分析显示治疗组治疗后Vt有非常显著下降 (P <0 .0 1) ,Vt2 、SPAP有显著下降 (P <0 .0 5 ) ;对照组治疗前后各指标无明显变化 ,两组比较 ,银杏叶片与安慰剂治疗效果有显著差异。结论 :本研究表明银杏叶片可显著降低SPAP ,可用于肺心病的防治。     

对无创伤性方法诊断肺动脉高压和肺心病的评价

肺动脉高压和肺原性心脏病的病因很多,最常见的是继发于慢性阻塞性肺病(COPD),而肺血管阻力增加所致的肺动脉高压又是COPD继发肺心病的先决条件,故一般认为肺心病人一定伴发肺动脉高压,肺动脉压的测量最好是用Swan-Gang漂浮导管直接插入肺动脉获取的数据,但此法有一定创伤,且费用昂贵,难以反复测定和推广,为此国内近十年来对各种无创伤性方法进行了大量研究,企图找到一种较好的方法代替导管估测肺动脉压,     

缺氧对老年肺心病患者甲状腺激素水平的影响

目的　探讨缺氧对老年肺心病患者甲状腺激素的影响。　 方法　使用放免法测定 68例老年肺心病急性期、2 8例缓解期及 2 8例对照组患者体内血清三碘甲状腺原氨酸 (T3)、四碘甲状腺原氨酸 (T4 )、促甲状腺激素(TSH)水平 ,同步测定动脉血中氧分压 (PaO2 )。观察T3、T4 和TSH的变化 ,并分析PaO2 与T3、T4 的相关关系。　 结果　老年肺心病急性期的血清T3、T4 水平分别轻度 :(0 70± 0 15 )、(61 7± 12 1)g·L-1;中度 :(0 48± 0 13)、(32 32± 7 9)g·L-1,重度 :(0 2 3± 0 0 9)、(18 7± 4 7)g·L-1。 3组血清T3、T4 显著低于缓解期 (0 88± 0 17)、(75 7± 15 6)g·L-1和对照组 (0 9± 0 35 )、(83 7± 14 6)g·L-1(P <0 0 1)。动脉血氧分压 (PaO2 )与T3、T4 水平是正相关 (P <0 0 5 ) ,轻、中、重度组和缓解组血清TSH较对照组略高 ,但无统计学意义 ,P >0 0 5。　 结论 　缺氧导致肺心病患者体内的甲状腺激素变化 ,并随着病情加重T3、T4 水平显著降低。监测血清T3、T4 水平有助于判断肺心病危重程度及其预后预测     

缺氧肺动脉平滑肌细胞增殖研究进展

缺氧时肺动脉平滑肌细胞的增殖在肺血管重构、缺氧性肺动脉高压的形成中有重要作用,但其作用机制仍不完全清楚。本文就缺氧对肺动脉平滑肌细胞增殖的影响及其可能机制作一综述。     

内皮素与老年人慢性肺心病肺动脉高压的关系

内皮素与老年人慢性肺心病肺动脉高压的关系孙培宗，秦省，王静内皮素（ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）是强大的血管收缩剂，具有促进血管平滑肌细胞增殖的能力。我们对２３例老年肺心病患者用右心微导管监测血液动力学指标并测定血浆内皮素水平，探讨内皮素在老年人继发性...     

肺动脉高压诊断标准和慢性肺心病定义

本复习了国外献中关于肺动脉高压的不同诊断角度，方法及其数值标准和有关慢性肺心病定义的描述，并对肺动脉高压和肺心病的关系进行了分析，以期对国外肺动脉高压的诊断标准和慢性肺心病的定义有一概要了解，为国内修订相应的标准和定义提供参考。     

伴或不伴冠心病的原发性高血压患者心功能比较

５４例原发性高血压患者冠状动脉造影检查，按其结果是否守主动脉 狭窄≥７０％为Ⅰ组，Ⅱ组３１例，结果表明，Ⅰ组年龄明显高于Ⅱ组。Ⅰ组人武部伴有典型心绞痛和心电图ＳＴ 水平下移≥０．０５ｍＶ，而Ⅱ组人武部伴有典型心绞痛和心电图ＳＴ水平下移≥０．０５ｍＶ，而Ⅱ组各点５１．６％和９．７％。     

Right Ventricular Outflow Tract Tumor Mimicking a Thrombus in the Main Pulmonary Artery

Primary sarcomas of the pulmonary artery and right 'ventricle are rare, and their presentation is unusual in clinical practice; therefore, their diagnosis is often missed or delayed. The progression of the obstruction from the outflow tract of the right ventricle to the pulmonary artery resembles massive pulmonary embolism. We present a case of one of these tumors which mimicked transesophageal echocardiography (TEE), a massive pulmonary embolism. We conclude that TEE represents a non-invasive method of diagnosis and evaluation when the suspicion is massive pulmonary thromboembolism or a heart tumor.     

Right Ventricular Function in Adult Patients with Eisenmenger Physiology: Insights from Quantitative Echocardiography

Background: The favorable outcomes of Eisenmenger syndrome (ES) relative to other forms of pulmonary arterial hypertension (PAH) have been partially attributed to a unique adaptation of the right ventricle (RV). However, conventional measures of RV function may not adequately express this adaptation. Methods: We studied 23 patients with ES (age 43 ± 17 years, 16 women, pulmonary artery systolic pressure [PASP] 93 ± 26 mmHg), 25 patients with PAH (age 44 ± 13 years, 17 women, PASP 92 ± 19 mmHg), and 25 subjects without known structural disease (age 45 ± 16 years, 17 women). We evaluated long‐ and short‐axis function of the RV with two‐dimensional strain and anatomical M‐mode echocardiography, respectively. Results: Long‐axis function of the RV was comparable between patients with ES and PAH although depressed relative to controls (global strain, ?15.6 ± 4.7, ?14.9 ± 4.3, and ?22.4 ± 2.8%, respectively, P < 0.001; global RV systolic strain rate, ?0.77 ± 0.26, ?0.84 ± 0.24, and ?1.11 ± 0.21 1/sec, respectively, P < 0.001). However, short‐axis RV function was significantly better in patients with ES versus those with PAH and preserved relative to controls (RV fractional shortening by anatomical M‐mode, median [interquartile range], 21%[14–33%], 14%[10–16%], and 26%[22–36%], respectively, P = 0.002 for ES vs. PAH, P = 0.09 for ES vs. controls). This differential was not reflected in conventional measures of RV function (fractional area change, 32 ± 10 vs. 29 ± 8% in ES and PAH, respectively, P = 0.26). Conclusion: In patients with ES, the RV is characterized by preserved short‐axis function, despite a depressed long‐axis function. Thus, conventional assessment of RV function might not be suitable for patients with ES. (Echocardiography 2010;27:937‐945)     

Pulmonary Production of Osteopontin in Humans: Effects of Left Ventricular Systolic Dysfunction and Cardiopulmonary Bypass

BackgroundWe evaluated pulmonary production of osteopontin (OPN) in left ventricular systolic dysfunction (LVSD) and after cardiopulmonary bypass surgery (CPB). OPN is a phosphoglycoprotein involved in inflammation and remodeling. In subjects with LVSD, plasma OPN correlates with prognosis but its origin is unknown. We hypothesized that the lungs produce OPN and that this could be affected by LVSD and CPB.Methods and ResultsSubjects with (n = 57; left ventricular ejection fraction [LVEF] 32 ± 8%) and without (n = 63; LVEF 59 ± 7%) LVSD were studied during CPB. Arterial and venous OPN plasma levels were determined. Arterial and venous OPN levels were higher in LVSD (P = .0290). For both groups, levels dropped 1 hour after surgery and nearly doubled 24 hours after (P < .0001 vs basal). Notably, there was a significant positive arteriovenous gradient with arterial levels higher than venous levels. Arteriovenous differences were statistically significant at baseline (P = .0120) and 1 hour (P < .0001) but not at 24 hours (P = .0649). Arterial levels in heart failure correlated inversely with renal function (P = .016) and positively with mean pulmonary pressure (P = .028), heart rate (P = .036), and C-reactive protein (P = .047).ConclusionsThere is production of circulating OPN by the lungs, unaffected by LVSD or CPB. This likely represents an overflow from local lung production and does not contribute to increased levels in LVSD or after CPB.     

成人先天性心脏病肺动脉高压的新认识

成人先天性心脏病患者表现为一个正在扩大的并需要终身接受3级护理的群体。一些成人先心病的患者最后发展为不同程度的肺动脉高压,影响患者的生存质量,发病率和病死率。然而近期对肺动脉高压病理生理学理解的提高和靶向治疗的出现使人们在成人先天性心脏病肺动脉高压患者病因学、临床表现、预后和治疗策略方面有了新的认识。     

丹红注射液对慢性肺源性心脏病患者肝细胞生长因子与肺动脉高压的影响

目的探讨肝细胞生长因子(HGF)与慢性肺源性心脏病的关系,揭示丹红注射液抑制肺动脉高压的作用机制。方法将符合诊断标准的56例肺源性心脏病患者随机分为治疗组和对照组各28例。对照组采用常规治疗,即持续低流量吸氧、抗感染、改善通气、祛痰止咳、平喘、强心利尿、扩血管、纠正水电解质紊乱与酸碱平衡失调等综合治疗。治疗组除按对照组上述方法处理外,加用丹红注射液20 ml加入5%葡萄糖或0.9%氯化钠溶液250 ml中静脉滴注,1次/d,14 d为1个疗程。两组均于治疗前后测定肺动脉压、做血气分析、判定疗效,并采血检测血浆HGF浓度。结果与对照组相比,治疗组经加用丹红注射液治疗后,患者的临床症状好转;肺动脉高压、PaCO2降低,PaO2升高(P<0.05,P<0.01),同时血浆HGF降低。结论加用丹红治疗可以明显改善慢性肺心病患者的临床症状和血气分析指标,降低肺动脉压力,同时伴随血清HGF含量的明显降低,提示丹红治疗可能通过某些途径刺激肺心病患者肺血管内皮HGF表达升高,这可能是其降低肺动脉压,发挥抗肺心病的重要作用机制之一。     

Pulmonary Hypertension,Right Ventricular Function,and Clinical Outcome in Acute Decompensated Heart Failure

BackgroundPulmonary hypertension (PH) and right ventricular (RV) dysfunction have been associated with adverse outcome in patients with chronic heart failure. However, data are lacking in the setting of acute decompensated heart failure (ADHF). We sought to determine prognostic significance of PH in patients with ADHF and its interaction with RV function.MethodsWe studied 326 patients with ADHF. Pulmonary artery systolic pressure (PASP) and RV function were determined with the use of Doppler echocardiography, with PH defined as PASP >50 mm Hg. The primary end point was all-cause mortality during 1-year follow-up.ResultsPH was present in 139 patients (42.6%) and RV dysfunction in 83 (25.5%). The majority of patients (70%) with RV dysfunction had PH. Compared with patients with normal RV function and without PH, the adjusted hazard ratio (HR) for mortality was 2.41 (95% confidence interval [CI] 1.44–4.03; P = .001) in patients with both RV dysfunction and PH. Patients with normal RV function and PH had an intermediate risk (adjusted HR 1.78, 95% CI 1.11–2.86; P = .016). Notably, patients with RV dysfunction without PH were not at increased risk for 1-year mortality (HR 1.04, 95% CI 0.43–2.41; P = .94). PH and RV function data resulted in a net reclassification improvement of 22.25% (95% CI 7.2%–37.8%; P = .004).ConclusionsPH and RV function provide incremental prognostic information in ADHF. The combination of PH and RV dysfunction is particularly ominous. Thus, the estimation of PASP may be warranted in the standard assessment of ADHF.     

超声心动图评价肺动脉高压患者右室功能的研究进展

肺动脉高压的发展会导致患者右室功能减低,对肺动脉高压患者右室功能的评价对其预后具有十分重要的临床意义。随着超声技术的不断发展,特别是新型超声技术的出现能敏感、准确地定量反映肺动脉高压患者的右室功能。现就目前超声心动图技术在评价肺动脉高压患者右室功能中的应用做一综述。     

肺动脉高压患者右室功能的多普勒超声评价与进展

肺动脉高压会导致患者右室功能减低,早诊断、早治疗肺动脉高压能明显改善患者的预后。近年来应用多普勒超声技术对肺动脉高压患者右室功能研究的新进展层出不穷,如双多普勒同步技术、Tei指数及三尖瓣环收缩期位移等,均为临床提供了全新的评价肺动脉高压及右室功能的新手段及新参数。     

肺动脉高压合并小缺损先天性心脏病的认识与研究进展

先天性心脏病患者中接受手术治疗的群体正在扩大,先天性心脏病相关性肺动脉高压临床分型中肺动脉高压合并小缺损先天性心脏病概念的提出意义深远,对以往手术治疗的小缺损先天性心脏病患者在治疗方面可能出现争议。