结核性毁损肺相关肺动脉高压患者的临床特点分析

doi:10.19871/j.cnki.xfcrbzz.2025.02.008

摘要/Abstract

摘要： 目的分析结核性毁损肺（tuberculosis-destroyed lung,TDL）相关肺动脉高压（pulmonary arterial hypertension,PH）患者的基本人口学信息、实验室检查、影像学、超声心动图及血流动力学、相关临床特点,为其诊治提供临床依据。方法回顾性收集2023年7月1日至2024年6月30日于重庆市公共卫生医疗救治中心住院的TDL相关PH患者44例,收集患者的基本人口学信息、毁损肺程度、实验室检查、影像学、超声心动图及右心导管检查等资料,分析患者的临床特点。结果 TDL相关PH患者年龄（56.64±11.10）岁,体重指数（body mass index,BMI）（17.95±2.87）kg/m²,男性占比是女性的2.1倍。D-二聚体水平1.06（0.42,2.02）mg/L,N末端B型钠尿肽前体水平（N-terminal pro-B-type natriuretic peptid,NT-proBNP）水平453.00（191.00,1178.00）pg/ml,毁损部位累及左肺占比最高（54.55%）,29例（65.91%）合并有支气管扩张,23例(52.27%)合并肺空洞,43例(97.73%)合并胸膜增厚。超声心动图检测肺动脉收缩压53.00（40.25,60.75）mmHg,且女性患者肺动脉主干内径宽于男性（P<0.05）,完善右心导管检查的患者平均肺动脉压31.00（29.00,35.25）mmHg,肺血管阻力6.02（3.87,8.91）WU。结论 TDL相关PH患者BMI水平偏低,男性占比高于女性,伴有D-二聚体及NT-proBNP水平升高,毁损部位好累及左肺,合并多种肺组织破坏,血流动力学指标提示肺血管阻力明显升高。

关键词: 结核, 毁损肺, 肺动脉高压, 临床特点

Abstract: Objective To analyze the laboratory tests, imaging, echocardiography and hemodynamic characteristics of pulmonary hypertension (PH) associated with tuberculous lung destruction, and to provide clinical evidence for the diagnosis and treatment of such patients. Method A retrospective collection was made of 44 patients with PH associated with tuberculous lung destruction who were hospitalized at Chongqing Public Health Medical Treatment Center from July 1, 2023 to June 30, 2024. Basic demographic information, the extent of lung destruction, laboratory tests, imaging, echocardiography and right heart catheterization data of the patients were collected, and the clinical characteristics of the patients were analyzed. Result The age of patients with PH associated with tuberculous lung destruction was (56.64±11.10) years, and the body mass index (BMI) was (17.95±2.87)kg/m². The proportion of male patients was 2.1 times that of female patients. D-dimer was 1.06 (0.42, 2.02)mg/L, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 453.00(191.00,1178.00)pg/ml. The left lung was the most frequently involved site of destruction (54.55%). Bronchiectasis was present in 29 cases (65.91%), and pulmonary cavities in 23 cases (52.27%). Pleural thickening was present in 43 cases (97.73%). The estimated pulmonary artery systolic pressure by echocardiography was 53.0 (40.25, 60.75) mmHg. The diameter of the main pulmonary artery was wider in female patients than in male patients (P<0.05). The mean pulmonary artery pressure (mPAP) of the 12 patients who underwent right heart catheterization was 31.00 (29.00, 35.25) mmHg, and the pulmonary vascular resistance (PVR) was 6.02 (3.87, 8.91) WU. Conclusion Patients with PH associated with tuberculous lung destruction have a low BMI level, a higher proportion of male patients than female patients, elevated D-dimer and NT-proBNP, and the destruction often involves the left lung. They also have multiple lung destructions, and hemodynamic indicators suggest a significant increase in PVR.

Key words: Tuberculosis, Destroyed lung, Pulmonary hypertension, Clinical characteristics

中图分类号:

孙楠楠, 熊艳美, 杨松, 岑武强, 刘雪艳. 结核性毁损肺相关肺动脉高压患者的临床特点分析[J]. 新发传染病电子杂志, 2025, 10(2): 40-46.

Sun Nannan, Xiong Yanmei, Yang Song, Cen Wuqiang, Liu Xueyan. Analysis of clinical characteristics of patients with TB-damaged pulmonary hypertension[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(2): 40-46.

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