Clinical Analysis Of Connective Tissue Disease-related Pulmonary Hypertension

ObjectiveThis article aims to evaluate the factors related to PAH in patients with CTD,including clinical manifestations and laboratory tests.The characteristics of CTH in patients with CTD are discussed.The aim is to provide a basis for the early diagnosis of secondary PAH in patients with CTD.MethodsA retrospective analysis of 864 patients admitted to the First Hospital of Jilin University from January 2015 to June 2018,including 433(50.11%)of systemic lupus erythematosus(SLE)and systemic sclerosis(SSc)52 Case(6.01%),polymyositis(DM)in 35(4.05%),Sjogren's syndrome(ss)in 218(25.22%),mixed connective tissue disease(MCTD)in 126(14.58%).According to the standard,84 patients with PAH secondary to the above CTD were diagnosed,including 79 females and 5 males;aged 13-75 years,mean(54±13)years old,SLE 37 cases(44.05%),SSc8 cases(9.52%)There were 23 cases of MCTD(27.38%),13 cases of SS(15.48%),and DM3 cases(3.57%)using SPSS 20.0 statistical software.Correlation analysis of non-continuous variables in this data was performed using Spearson correlation coefficient;statistical differences in count data were compared using independent sample t test and one-way ANOVA.Correlation analysis was performed using linear regression analysis.The difference was statistically significant at P < 0.05..ResultsIn 84 patients,UCG showed reflux flow signal and turbulence spectrum in the right atrial systolic phase of the tricuspid valve.Pulmonary systolic pressure fluctuated from 31 to 128 mmHg,with an average of(67.1 ± 20.2)mmHg,of which mild There were 11 cases of increase,52 cases of moderate increase,and 21 cases of severe increase.Among 84 patients with CTD-PAH,SLE was the main,accounting for 44.05%.Others were MCTD,Sjogren's syndrome,SSc,etc.Among them,MCTD and SSc had the highest incidence of PAH,18.25% and 15.38 respectively.%.The incidence of PAH in various CTDs was statistically significant.There was no significant difference in the mean pulmonary artery pressure between the MCTD group and the SSc group(P>0.05).The most frequent occurrence of common symptoms of CTD-PAH is Raynaud's phenomenon.The details are as follows: 38 cases of Renault phenomenon(45.24%),30 cases of chest tightness(35.71%),16 cases of fever(19.05%),3 cases of epilepsy(3.57%),10 cases of oral ulcers(11.90%)),19 cases(22.62%)with serositis,13 cases(15.48%)with dry mouth and dry eyes,and 12 cases(15.2%)with hair loss.The incidence of Raynaud's phenomenon was lower in patients with CTD-PAH.The CTD patients with PAH were high,and the difference was statistically significant(P<0.01).In addition,the relationship between Raynaud's phenomenon and pulmonary artery pressure in patients with PAH was linearly analyzed to obtain a positive correlation(r=0.407,P<0.01).The independent samples were used to compare the differences between the test and the results of the mild PAH group and the moderate-to-severe PAH group(see Table 2),anti-ANA(+)71 cases(84.52%),anti-Ds-DNA(+)11 cases(13.10%),anti-SM(+)21 cases(25.00%),anti-U1RNP(+)37 cases(44.05%),anti-SSA(+)44 cases(52.38%),anti-SSB(+)13 cases(15.48%),55 cases(65.48%)of pericardial effusion,31 cases(36.90%)of interstitial pneumonia,including anti-U1RNP(+)(r=0.385,P<0.01),pericardial effusion(r =0.195,P<0.05),pulmonary interstitial lesions(r=0.234,P<0.05)were statistically significant in patients with mild PAH and moderate to severe PAH.ConclusionThe incidence of PAH in MCTD and Sc patients was higher than that in other CTD patients.Reynolds phenomenon,age,pericardial effusion and pulmonary interstitial lesions suggest that CTD patients have a higher risk of PAH than other patients,so early diagnosis and treatment should be made.Pulmonary artery pressure in CTD-PAH patients with Reynolds phenomenon and larger right ventricular diameter was higher than that in CTD-PAH patients without Reynolds phenomenon.