Gläser Sven, Noga Oliver, Koch Beate, Opitz Christian F, Schmidt Bernd, Temmesfeld Bettina, Dörr Marcus, Ewert Ralf, Schäper Christoph
Division of Pulmonary Medicine and Infectious Diseases, University of Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany.
Respir Med. 2009 Feb;103(2):317-24. doi: 10.1016/j.rmed.2008.08.005. Epub 2008 Sep 18.
Pulmonary hypertension is a relevant interceding morbidity in patients with pulmonary fibrosis that has significant impact on exercise tolerance and outcome. The aim of this study was to further characterize the exercise intolerance, dyspnoea and ventilatory inefficiency of patients with pulmonary fibrosis in the presence or absence of pulmonary hypertension via cardiopulmonary exercise testing. Thirty-four patients underwent pulmonary function testing, symptom-limited exercise testing on a bicycle and dyspnoea evaluation according to the BORG scale. Pulmonary hypertension was assessed by echocardiography and in a subset of patient's right heart catheterization. Sixteen of 34 patients with pulmonary fibrosis revealed pulmonary hypertension. While all study patients did not differ in lung functions and demographic characteristics, patients suffering from pulmonary hypertension showed a significantly impaired exercise tolerance and worsened ventilatory inefficiency. The extent of pulmonary artery pressure elevation impacted significantly on ventilatory inefficiency. In addition, the increased ventilatory requirements significantly influenced the extent of dyspnoea in patients with pulmonary hypertension. We conclude that pulmonary hypertension has a significant impact on exercise capacity and dyspnoea in patients with interstitial lung disease (ILD). The further impairment of exercise capacity as well as the extent of dyspnoea in patients with interceding PHT is attributable to a significantly impaired ventilatory inefficiency.
肺动脉高压是肺纤维化患者中一种相关的中间发病情况，对运动耐量和预后有重大影响。本研究的目的是通过心肺运动试验，进一步描述存在或不存在肺动脉高压的肺纤维化患者的运动不耐受、呼吸困难和通气效率低下情况。34例患者接受了肺功能测试、症状限制的自行车运动测试以及根据BORG量表进行的呼吸困难评估。通过超声心动图对肺动脉高压进行评估，并对部分患者进行右心导管检查。34例肺纤维化患者中有16例存在肺动脉高压。虽然所有研究患者的肺功能和人口统计学特征无差异，但患有肺动脉高压的患者运动耐量明显受损，通气效率低下情况恶化。肺动脉压力升高的程度对通气效率低下有显著影响。此外，通气需求增加对肺动脉高压患者的呼吸困难程度有显著影响。我们得出结论，肺动脉高压对间质性肺疾病（ILD）患者的运动能力和呼吸困难有重大影响。合并肺动脉高压的患者运动能力的进一步受损以及呼吸困难的程度归因于通气效率的显著受损。
