中文摘要（第一部分）

超声心动图在正常人与特发性肺动脉高压患者右心功能评估中的应用

目的：肺动脉高压(pulmonary arterial hypertension，PAH)属于一种极为罕见的疾病，了解到其是一种病理生理综合症，肺血管阻力升高是其主要特征。同时，肺动脉收缩压（pulmonary artery systolic pressure，PASP）亦是明显的病理特征。过去，有关心功能的研究多以左心室为主，但近年来，研究者们注意到，右室对于血流动力学具有关键的影响作用。目前已有多种临床手段来评价右心功能，例如超声心动图。超声心动图由于其安全、方便、价格低廉等优点，已逐渐被应用于临床上的首选检查方法。本文应用常规超声心动图， 并结合实时三维超声心电图（ real time three-dimensional echocardiography，RT-3DE）技术对特发性肺动脉高压（idopathic pulmonary arterial hypertension，IPAH）患者的右心室进行相关分析，并将 RT-3DE 与常规超声进行对比，以探讨 RT-3DE 对 IPAH 病人实际影响，具体探讨临床价值， 从而分析这一技术对病人右心室收缩功能等方面的实际影响，具有临床意义。此外， 也利于更好的分析血液动力学方面的内容。

资料与方法：选择本院 2019 年 1~2022 年 2 月共 120 例 IPAH 病人。另外，以40 例健康体检对象为对照组。采用超声心动图测量受检者右心结构相关参数，包括左心室横径（left ventricular transverse diameter，LVTD）、右心室横径（right ventricular transverse diameter，RVTD）、三尖瓣环收缩期位移(tricuspid annulus plane systolic velocity，TAPSE)、Tei 指数、三尖瓣环收缩期峰值速度(peak systolic velocity，S')、每搏输出量（stroke volume，SV）及 PASP、右心输出量（right ventricular output， RCO）、肺动脉舒张压（pulmonary artery diastolic pressure，DPAP）、肺动脉平均压（mean pulmonary artery pressure，MPAP）。通过 RT-3DE 测量患者的右心室整体舒张末期容积（EDV）、右心室射血分数（RVEF）、右心室收缩末期容积（ESV）。将 PH 组与健康对照组的右心室结构参数和血液动力学指标的差异进行比较。

结果： 1.  PAH 组 RVTD、 EDV、 ESV 均高于健康组（P<0.05), LVTD、 S V、 RVEF 均明显低于健康对照组，差异有统计学意义（P<0.05)。2.在 SPAP、 D PAP 和 MPAP 的比较中，健康对照组低于 PH 组， 但是 RCO 值明显高于 PH 组（P

<0.05）。3. 将 40 例对照者进行常规超声与 RT-3DE 的评估，健康对照组组织多普勒显像（tissue doppler imaging，TDI）条件下测得的三尖瓣瓣环Ｓ’以及右室游离壁三尖瓣瓣环处 Tei 指数与 RT-3DE 测得的 RVEF 具有显著相关性。Ｍ型超声心动

图测得的 TAPSE 与 RT-3DE 测得的 RVEF 值之间也存在显著相关性。

结论：特发性肺动脉高压患者的右心功能降低，超声心动图对该类患者的心功能的评估作用良好。

中文摘要（第二部分）

超声心动图评价不同程度特发性肺动脉高压患者右心功能的临床研究

目的：特发性肺动脉高压(idopathic pulmonary arterial hypertension，PAH）患者可依据肺动脉收缩压的不同，分为轻、中、重度患者，中、重度的 IPAH 患者右心功能不同程度的减低，当心功能受损到一定程度，在此过程中，会相继的出现一系列病症，例如右心室相比较于以往来说显著增大等，最终伴发右心衰竭。在第一部分中，我们采用超声心动图对 IPAH 患者的右心功能进行了评价，发现其有良好的应用价值，在此基础上我们继续采用超声心动图对不同程度特发性肺动脉高压患者的右心功能进行检测，探讨其对肺动脉高压分级之间的价值，以期为临床对 I PAH 患者的诊断、治疗起到一定的指引作用。

资料与方法：选取 2019 年 1 月至 2022 年 2 月我院收治的特发性肺动脉高压

患者 120 例。根据肺动脉收缩压将 120 例患者分为轻度患者 40 例、中度患者 52 例

和重度患者 28 例。采用超声心动图测量受检者右心结构相关参数，包括左心室横径（ left ventricular transverse diameter， LVTD）、右心室横径（ right ventricular transverse diameter，RVTD）、三尖瓣环收缩期位移(tricuspid annulus plane systolic velocity，TAPSE)、Tei 指数、三尖瓣环收缩期峰值速度(peak systolic velocity，S')、每搏输出量（stroke volume，SV）及 PASP、右心输出量（right ventricular output， RCO）、肺动脉舒张压（pulmonary artery diastolic pressure，DPAP）、肺动脉平均压（mean pulmonary artery pressure，MPAP）。通过 RT-3DE 测量患者的右心室整体舒张末期容积（end diastolic volume，EDV）、右心室射血分数（right ventricular ejection fraction，RVEF）、右心室收缩末期容积（end systolic volume，ESV）。比较不同程度 PAH 患者右心结构的相关参数及血流动力学参数方面的差异。

结果：1.比较轻、中、重度 IPAH 患者右心室结构的参数，中重度 PAH 组RVTD、 EDV、 ESV 参数明显高于轻度 PAH 组，而 LVTD、SV、RVEF 均明显低于轻度 PAH 组患者（P<0.05）。2. 在 SPAP、 DPAP、MPAP 指标上，中、重度 PAH 患者明显高于轻度 PAH，差异具有统计学意义（P<0.05)。3. DPAP、MPAP 指标中， 中度 PAH 组与重度 PAH 组患者两者之间没有明显差异（P>0.05）；RCO 在轻度PAH 组、中度 PAH 组和重度 PAH 组患者之间呈现下降趋势（P<0.05）。4. 将 28 例重度 PH 患者进行常规超声与 RT-3DE 的评估，TDI 条件下测得的三尖瓣环 S'、右室游离壁三尖瓣瓣环处Tei 指数以及Ｍ型超声心动图测得的TAPSE 与RT-3DE 测

得的 RVEF 具有良好的相关性。

结论：1. 经过研究分析得到以下结论，肺动脉收缩压增高也会影响到右室容积变化，二者呈现正比例发展关系。但在此基础上，收缩功能随之降低；2.采用超声心动图能够良好的对不同分度特发性肺动脉高压患者进行右心功能的测量，有助于临床干预决策的制定。

中文摘要（第三部分）

西地那非治疗特发性肺动脉高压的效果及影响因素分析

目的：探讨西地那非治疗特发性肺动脉高压(IPAH)的效果，并分析其影响临床疗效的相关因素。

方法：选取 2019 年 1 月至 2022 年 2 月我院收治的 IPAH 患者 120 例作为观察对象，均给予西地那非治疗，治疗 6 个月时评估疗效，将患者分为西地那非治疗有效组和无效组，对资料进行研究分析，同时需对两组的各项指标进行对比，包括临床化验指标等。采用 Logistic 回归分析患者经西地那非治疗效果的影响因素。

结果：接受西地那非治疗的 120 例 IPAH 患者中，治疗有效 75 例，有效率为62.50%，无效 45 例，无效率为 37.50%。治疗有效组和无效组的各方面信息，例如个人情况以及身体状况等，包括合并贫血、WHO 心功能分级、RVTD、LVTD、EDV、ESV、SV、RVEF、6MWD、NT-proBNP 和 SPAP 等方面比较，差异均无统计学意义（P>0.05）； 无效组合并糖尿病的比例高于有效组，出现症状到诊断时间长于有效组(P<0.05)； 无效组 RAP、PVR 高于有效组，SaO2、SVO2 和 CI 低于有效组(P<0.05)。将单因素分析结果中差异有统计学意义的危险因素进行多元回归分析，即以合并糖尿病、出现症状到诊断时间、RAP、PVR、SaO2、SVO2 和 CI 为自变量，以患者治疗有效或无效为因变量，纳入模型并进行多因素 Logistic 回归分析，结果显示，患者治疗前 SVO2 是西地那非疗效的保护因素（OR=0.481），合并糖尿病（OR=285.256）、出现症状到治疗时间（OR=1.842）和 RAP（OR=1.786）是西地那非疗效的危险因素（P<0.05）。

结论：采用西地那非治疗 IPAH 患者具有一定的效果，但同时要注意，合并糖尿病、出现症状到治疗时间和 RAP 相对偏大的患者的疗效可能受到影响，因此需积极纠正血糖，并尽早诊断和积极治疗有望进一步改善患者的预后。

Abstract (Part 1)

Application of echocardiography in assessment of right ventricular function in normal subjects and patients with idopathic pulmonary hypertension

Objective: Pulmonary arterial hypertension (PAH) is a kind of pulmonary circulation hypertension. It is a group of pathophysiological syndrome characterized by pulmonary vascular resistance and pulmonary artery systolic pressure (PASP). In recent years, researchers have found that the right ventricle plays an important role in maintaining hemodynamics, so they pay more attention to it. At present, there are many methods to evaluate the right ventricular function, such as right heart catheterization, echocardiography and so on. In contrast, echocardiography is not only safe and convenient, but also cheap, which has become the first choice in clinical examination. The purpose of this study was to compare the value of real-time echocardiography and echocardiography in patients with idiopathic pulmonary hypertension.

Methods: 120 patients with idiopathic pulmonary hypertension in our hospital from January 2019 to February 2022 were selected. Another 40 healthy people in the same period were selected as the healthy control group. Echocardiography was used to measure the structural parameters of the right heart, including transverse diameter (LVTD), transverse diameter (RVTD), tricuspid annular systolic velocity (TAPSE), Tei index, peak systolic velocity (S') Stroke volume (SV) and PASP, right ventricular output (RCO), pulmonary artery diastolic pressure (DPAP), and mean pulmonary artery pressure (MPAP). end systolic volume (ESV) were measured by RT-3DE. The differences of right ventricular structure parameters and hemodynamic parameters between pH group and healthy control group were compared.

Results: 1. The RVTD, EDV and ESV of PAH group were higher than those of healthy group (P < 0.05), while LVTD, SV and RVEF of PAH group were lower than those of healthy control group (P < 0.05). 2. The SPAP, DPAP and MPAP of the two groups were compared. The healthy control group was lower than the pH group, while the RCO was higher than that of the PAH group (P < 0.05). 3. 40 healthy controls were evaluated by

conventional ultrasound and RT-3DE. The s' of tricuspid annulus measured by Tissue Doppler imaging(TDI) and Tei index at tricuspid annulus of right ventricular free wall were significantly correlated with RVEF measured by RT-3DE. There was also a significant correlation between TAPSE measured by M-mode echocardiography and RVEF measured by RT-3DE.

Conclusions: Right ventricular patients idiopathic is decreased, and echocardiography can evaluate the cardiac function of these patients.

Abstract  (Part  2)

Evaluation of right ventricular function in patients with different degrees of idopathic pulmonary hypertension by echocardiography

Objective: Based on patients with IPAH patients can be divided into mild, medium, and severe IPAH patients with different degree of right heart function to reduce, be ware of impaired to a certain extent and cannot compensate for the impaired by itself, will be the emergence of secondary myocardial hypertrophy and ventricular enlargement, reduced left ventricular ejection fraction and so on, with right heart failure in the end. In the first part, we use the echocardiography of right heart function in patients with IPAH is evaluated, and found that it has good application value, on this basis we continue using echocardiography of right heart function in patients with different degree of pulmonary hypertension, discuss its value of patients with IPAH play a guide role.

Methods: 120 patients with idiopathic pulmonary hypertension admitted to our hospital from January 2019 to February 2022 were selected. According to pulmonary arterial systolic blood pressure, 120 patients were divided into mild patients (40 patients), moderate patients (52 patients) and severe patients (28 patients). Echocardiography was used to measure the structural parameters of the right heart, diameter (LVTD), transverse diameter (RVTD), tricuspid annular systolic velocity (TAPSE), Tei index, peak systolic velocity (S') ，stroke volume (SV) and PASP, right ventricular output (RCO), pulmonary artery diastolic pressure (DPAP), and mean pulmonary artery pressure (MPAP). right ventricular (ESV) were measured by RT-3DE.The differences in the parameters related to the right heart structure and hemodynamic parameters of patients with different degrees of IPAH were compared.

Results: 1. Compared the relevant parameters of right heart structure in patients with mild, moderate and severe IPAH, among which RVTD, EDV and ESV parameters in patients with moderate and severe PAH were higher than those in patients with mild PAH, while LVTD, SV and RVEF were lower than those in patients with mild PAH (P<0.05). 2. In terms of SPAP, DPAP and MPAP, moderate and severe PAH patients were all higher than those in the mild PAH group, with statistically significant differences (P<0.05). 3. In terms of DPAP and MPAP indexes, there was no significant difference between patients

in the moderate PAH group and those in the severe PAH group (P>0.05); RCO showed  an decreasing trend among patients of mild PAH group, moderate PAH group and severe PAH group (P<0.05). 4. Conventional ultrasound and RT-3DE were used to evaluate 28 patients with severe PH. The tricuspid annulus S' measured under TDI, the Tei index at the tricuspid annulus of the free wall of the right ventricle, and the TAPSE measured by M-mode echocardiography have good correlation with the RVEF measured by RT-3DE.

Conclusions: 1. With the increase of systolic blood pressure (PASP), volume increased gradually; 2. The use of echocardiography can well measure the right heart function of patients with different degrees of idopathic pulmonary hypertension, which is conducive to the decision making of clinical intervention.

Abstract (Part 3)

Analysis of the effect and influencing factors of sildenafil in the tr eatment of idopathic pulmonary arterial hypertension

Objective: To investigate the effect of sildenafil pulmonary arterial hypertension (IPAH), and to analyze the related factors affecting the clinical effect.

Methods: 120 patients with IPAH admitted to our hospital from January 2019 to February 2022 were selected as the observation objects. All patients were treated with sildenafil. The efficacy was evaluated after 6 months of treatment. The patients were divided into the effective group and the ineffective group. The general data, clinical laboratory indexes, echocardiographic parameters and right cardiac catheter parameters of the two groups were analyzed and compared. Logistic regression analysis was used to analyze the influencing factors of the effect of sildenafil treatment.

Results: Of the 120 patients with IPAH treated with sildenafil, 75 were effective, the effective rate was 62.50%, 45 were ineffective, and the ineffective rate was 37.50%. smoking, drinking, hypertension, chronic kidney disease, anemia, WHO cardiac function classification, RVTD, LVTD, EDV, ESV, SV, RVEF, 6MWD, NT proBNP and SPAP between the effective and ineffective groups (P>0.05); The proportion of ineffective combination with diabetes was higher than that of effective group, and the time from symptom to diagnosis was longer than that of effective group (P<0.05); RAP and PVR in the ineffective group were higher than those in the effective group, and SaO2, SVO2 and CI were lower than those in the effective group (P<0.05). Multivariate regression analysis was conducted for the risk factors with statistically significant differences in the results of univariate analysis, that is, with diabetes, time from symptom to diagnosis, RAP, PVR, SaO2, SVO2 and CI as independent variables, and with effective or ineffective treatment as dependent variables, the model was included and multivariate logistic regression analysis was conducted. The results showed that SVO2 was a protective factor for the efficacy of sildenafil before treatment (OR=0.481), Diabetes mellitus (OR=285.256), the time from symptom to treatment (OR=1.842), and RAP (OR=1.786) were the risk factors for the efficacy of sildenafil (P<0.05).

Conclusion: The use of sildenafil in the treatment of IPAH patients has a certain effect, but at the same time, it should be noted that the efficacy of patients with diabetes, symptoms to treatment time and relatively large RAP may be affected. Therefore, it is necessary to actively correct blood glucose, and early diagnosis and active treatment are expected to further improve the prognosis of patients.