纤维素性纵隔炎合并肺动脉高压患者超声心动图特征回顾性分析

Objective To analyze the echocardiographic characteristics of patients with fibrosing mediastinitis complicated with pulmonary hypertension (FM - PH), expand the diagnostic ideas of this disease, and provide useful references for clinical diagnosis, treatment and prognosis. Methods The medical records, echocardiographic parameters and image data of 78 patients with FM - PH diagnosed in our hospital were retrospectively analyzed. According to the estimated pulmonary artery systolic pressure (SPAP) by echocardiography, the patients were divided into 3 groups: group Ⅰ (36 mmHg ≤ SPAP < 50 mmHg), group Ⅱ (50 mmHg ≤ SPAP < 70 mmHg) and group Ⅲ (SPAP ≥ 70 mmHg). Combined with CT images and pathological results, a summary analysis was carried out. The echocardiographic parameters related to the degree of increase in SPAP in patients with FM - PH were analyzed by linear correlation. Results ① The clinical manifestations of 78 patients with FM - PH were diverse and atypical; ② The ratio of ventricular transverse diameter (RVTD/LVTD), the left - right diameter of the right atrium (RAD1), and the proportion of patients with decreased right ventricular systolic function gradually increased with the aggravation of PH (P < 0.05), and RAD1, the up - down diameter of the right atrium (RAD2), and RVTD/LVTD were positively correlated with the degree of PH (P < 0.05); ③ After 8 patients with FM - PH were treated with balloon pulmonary angioplasty (BPA), the SPAP of 5 patients decreased compared with that before BPA (P < 0.05). Conclusion FM - PH is rare in clinical practice and has non - specific manifestations. Echocardiography can comprehensively evaluate the cardiac structure, function and hemodynamic status of patients with FM - PH, and is an important examination method for evaluating and following up FM - PH.

目的分析纤维素性纵隔炎合并肺动脉高压(FM-PH)患者超声心动图特征,拓展该病诊断思路,为临床诊疗及预后提供有益参考。方法回顾性分析我院78例确诊FM-PH患者病历、超声心动图参数及图像资料。根据超声估测肺动脉收缩压(SPAP)分为3组:组Ⅰ(36 mmHg≤SPAP<50 mmHg)、组Ⅱ(50 mmHg≤SPAP<70 mmHg)及组Ⅲ(SPAP≥70 mmHg),结合CT图像和病理结果,进行汇总分析。与FM-PH患者SPAP升高程度相关的超声心动图参数采用线性相关分析。结果①78例FM-PH患者临床表现多样且不典型;②心室横径比值(RVTD/LVTD)、右房左右径(RAD1)、右室收缩功能减低者占比随PH程度加重而逐渐增加(P<0.05),且RAD1、右房上下径(RAD2)、RVTD/LVTD与PH程度呈正相关(P<0.05);③8例FM-PH患者行球囊肺动脉成形术(BPA)干预治疗后,5例患者SPAP较BPA术前下降(P<0.05)。结论FM-PH患者临床上罕见,表现不特异,超声心动图可综合评价FM-PH患者心脏结构、功能及血流动力学情况,是评估及随访FM-PH的重要检查手段。