Vonbank Karin, Funk Georg Christian, Marzluf Beatrice, Burian Bernhard, Ziesche Rolf, Stiebellehner Leopold, Petkov Ventzislav, Haber Paul
Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2008;120(23-24):749-55. doi: 10.1007/s00508-008-1103-5.
Pulmonary hypertension (PH) is common in patients with chronic obstructive pulmonary disease (COPD). Mean pulmonary artery pressure (mPAP) is often only slightly elevated at rest but is increased by exercise. The purpose of this study was to determine whether abnormal pulmonary artery pressure impairs exercise capacity in patients with COPD.
42 patients with moderate-to-very-severe COPD (28 men, 14 women) underwent symptom-limited incremental cardiopulmonary exercise testing and also right-heart catheterization at rest. Abnormal pulmonary artery pressure was defined as mPAP>20 mmHg at rest.
Resting mPAP was elevated in 32 patients (PH, mPAP=26.8+/-5.9 mmHg) and normal in 10 non-hypertensive (NPH) patients (NPH, mPAP=16.8+/-2 mmHg). There were no significant differences in lung function between the PH and NPH groups. Maximum oxygen uptake during exercise (VO2max) was significantly lower in PH (785+/-244 ml/min) than in NPH (1052+/-207 ml/min, P=0.004). Dead-space ventilation (Vd/Vt) was greater in PH (P=0.05) with higher VE/VCO2 (ratio of minute ventilation to carbon dioxide output=47.3+/-10 vs 38.6+/-3.5, P=0.025) and significantly higher arterial-end-tidal pCO2 difference [p(a-ET)CO2]. Pulmonary vascular resistance measured at rest correlated significantly with VO2max, VE/VCO2 and p(a-ET)CO2.
In patients with COPD, abnormal pulmonary artery pressure impairs gas exchange, decreases maximum oxygen uptake during exercise and impairs exercise capacity.
肺动脉高压（PH）在慢性阻塞性肺疾病（COPD）患者中很常见。平均肺动脉压（mPAP）在静息时通常仅略有升高，但运动时会升高。本研究的目的是确定异常肺动脉压是否会损害COPD患者的运动能力。
42例中重度至极重度COPD患者（28例男性，14例女性）进行了症状限制递增心肺运动试验，并在静息状态下进行了右心导管检查。异常肺动脉压定义为静息时mPAP>20 mmHg。
32例患者静息mPAP升高（PH组，mPAP = 26.8±5.9 mmHg），10例非高血压（NPH）患者静息mPAP正常（NPH组，mPAP = 16.8±２ mmHg）。PH组和NPH组的肺功能无显著差异。运动期间的最大摄氧量（VO2max）在PH组（785±244 ml/min）显著低于NPH组（1052±207 ml/min，P = 0.004）。PH组的死腔通气（Vd/Vt）更大（P = 0.05），VE/VCO2（分钟通气量与二氧化碳排出量之比 =47.3±10 比 38.6±3.5，P = 0.025）更高，动脉 - 呼气末二氧化碳分压差 [p(a - ET)CO2] 显著更高。静息时测量的肺血管阻力与VO2max、VE/VCO2和p(a - ET)CO2显著相关。
在COPD患者中，异常肺动脉压会损害气体交换，降低运动期间的最大摄氧量，并损害运动能力。
