Pulmonary Hypertension Program, Division of Pulmonary and Critical Care Medicine, Northwestern University, Suite 1400, Chicago, IL 60611, USA.
Respir Med. 2010 Dec;104(12):1877-82. doi: 10.1016/j.rmed.2010.05.009. Epub 2010 Jun 14.
The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant.
A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed.
4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01-1.50]) and PVH (HR 1.35 95%CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04-1.55], PVH: HR 1.40; 95%CI [1.13-1.73]).
PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.
肺动脉高压（PH）在 COPD 中的功能意义尚不清楚。本研究的目的是确定严重 COPD 患者中列出肺移植的 PH 的患病率、严重程度和相关的功能影响。
对 1997 年至 2006 年之间器官采购和组织网络（OPTN）数据库中以 COPD 为主要诊断的患者进行回顾性审查。分析了基线人口统计学、血液动力学、肺功能测试、六分钟步行距离测试（6MWD）和移植前生存数据。
4930 例 COPD 患者有可评估的右心导管检查数据（RHC）。30.4%存在 PH，其中肺动脉高压（PVH）占另外 17.2%的患者。PH 患者的步行距离平均比血液动力学正常的患者少 28 米。正常血液动力学组：261±104m，PH；238±106m（p<0.01），PVH：228±104m（p<0.05）。在多变量分析中，平均肺动脉压（β=-1.33;p=0.01）是 6MWD 降低的独立预测因子，用力肺活量（β=1.48;p<0.001）和患者年龄（β=-1.91;p<0.001）也是如此。PH（HR 1.23 95%CI [1.01-1.50]）和 PVH（HR 1.35 95%CI [1.11-1.65]）都被证明是等待名单上死亡的独立危险因素，即使在调整了年龄、性别、种族、BMI、肺功能、疾病严重程度和糖尿病后也是如此（PH：HR 1.27;95%CI [1.04-1.55]，PVH：HR 1.40;95%CI [1.13-1.73]）。
PH 在晚期 COPD 中很常见，与功能障碍和死亡率增加有关。根据 RHC 确定的肺血液动力学分层在区分不同的临床表型方面似乎很重要。
