与终末期慢性阻塞性肺疾病相关的肺动脉高压的患病率、预测因素和生存率。
Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease.
机构信息
Department of Cardiology, Pulmonary Vascular Program, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
出版信息
J Heart Lung Transplant. 2012 Apr;31(4):373-80. doi: 10.1016/j.healun.2011.11.020. Epub 2012 Jan 9.
BACKGROUND
The prevalence, prognostic importance, and factors that predict the presence and degree of pulmonary hypertension (PH) diagnosed with right heart catheterization (RHC) in patients with end-stage chronic obstructive pulmonary disease (COPD) remain unclear.
METHODS
This retrospective study included 409 patients (61% women) with COPD/emphysema or α-1-antitrypsin deficiency who underwent lung transplant evaluation during 1991 to 2010. We analyzed the occurrence and degree of PH and compared demographics, oxygenation, lung function, hemodynamics, functional capacity, and survival in patients with and without PH. Prediction of PH was assessed using univariate and multivariate regression analysis.
RESULTS
The mean age at evaluation was 54 ± 7 years. All patients were in New York Heart Association functional class III-IV, with forced expiratory volume in 1 second of 23% ± 7% and total lung capacity of 126% ± 21% of predicted. PH was present in 146 (36%). The analysis excluded 53 (13%) with pulmonary venous hypertension (PVH). The distribution of the mean pulmonary artery pressure (mPAP) in patients with or without PH showed a unimodal normally distributed population, with a mean of 23.8 ± 6.0 mm Hg. Predictors of PH were partial pressures of oxygen and carbon dioxide. The 5-year survival rate was 37% in COPD patients with PH vs 63% in patients without PH (p = 0.016). Survival after lung transplantation did not differ (p = 0.37).
CONCLUSIONS
RHC verified PH in 36% of COPD patients. Hypoxemia and hypercapnia were associated with mPAP. PH is associated with worse survival in COPD, but PH does not influence the prognosis after lung transplantation.
背景
在终末期慢性阻塞性肺疾病（COPD）患者中，通过右心导管检查（RHC）诊断的肺动脉高压（PH）的患病率、预后重要性以及预测 PH 存在和严重程度的因素仍不清楚。
方法
本回顾性研究纳入了 1991 年至 2010 年间接受肺移植评估的 409 例 COPD/肺气肿或α-1-抗胰蛋白酶缺乏症患者（61%为女性）。我们分析了 PH 的发生和严重程度，并比较了有和无 PH 的患者的人口统计学、氧合、肺功能、血液动力学、功能能力和生存情况。使用单变量和多变量回归分析评估 PH 的预测因素。
结果
评估时的平均年龄为 54 ± 7 岁。所有患者均处于纽约心脏协会功能分级 III-IV 级，第 1 秒用力呼气量为预计值的 23%±7%，总肺活量为预计值的 126%±21%。146 例（36%）存在 PH。分析排除了 53 例（13%）有肺静脉高压（PVH）的患者。有 PH 和无 PH 的患者的平均肺动脉压（mPAP）的分布呈单峰正态分布，平均为 23.8 ± 6.0mmHg。PH 的预测因素是氧分压和二氧化碳分压。有 PH 的 COPD 患者的 5 年生存率为 37%，无 PH 的患者为 63%（p=0.016）。肺移植后的生存率无差异（p=0.37）。
结论
RHC 证实 36%的 COPD 患者存在 PH。低氧血症和高碳酸血症与 mPAP 相关。PH 与 COPD 患者的生存率较差相关，但 PH 不影响肺移植后的预后。
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