毛细血管二氧化碳分压有助于鉴别特发性肺动脉高压与射血分数保留的心力衰竭所致肺动脉高压。
Capillary pCO2 helps distinguishing idiopathic pulmonary arterial hypertension from pulmonary hypertension due to heart failure with preserved ejection fraction.
作者信息
Olsson Karen M, Sommer Lisa, Fuge Jan, Welte Tobias, Hoeper Marius M
出版信息
Respir Res. 2015 Mar 10;16(1):34. doi: 10.1186/s12931-015-0194-6.
RATIONALE
The demographics of patients with idiopathic pulmonary arterial hypertension (IPAH) are changing and this diagnosis is increasingly being made in older patients. However, diagnostic misclassifications are common as it may be difficult to differentiate between IPAH and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). We investigated the hypothesis that the capillary pCO2 (pcCO2) may help distinguishing between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).
METHODS
In a cross-sectional study, we retrospectively assessed pcCO2 levels (obtained from arterialized capillary blood at the time of diagnosis) from patients with IPAH or PH-HFpEF, respectively. Receiver operated characteristics (ROC) were used to determine the pcCO2 level providing the best discrimination between these two conditions. PcCO2 values were considered helpful if they were associated with a negative predictive value >0.9 to excluded either IPAH or PH-HFpEF.
RESULTS
The study enrolled 185 patients, 99 with IPAH (74% female; age 47 ± 17 years; body mass index 26 ± 5 kg/m2, PAPm 53 ± 12 mmHg, PAWP 8 ± 3 mmHg), and 86 with PH-HFpEF (64% female; age 69 ± 10 years; body mass index 30 ± 6 kg/m2, PAPm 47 ± 10 mmHg, PAWP 21 ± 5 mmHg). PcCO2 at time of diagnosis was 33 ± 4 mmHg in the IPAH group and 40 ± 5 mmHg in the PH-HFpEF group (p < 0.001), respectively. According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.87 (p < 0.001). The likelihood of PH-HFpEF was <10% in patients with a PcCO2 < 34 mmHg, whereas the likelihood of IPAH was <10% in patients with a PcCO2 > 41 mmHg.
CONCLUSIONS
PcCO2 levels were significantly lower in IPAH compared to PH-HFpEF and may provide useful information in differentiating between both conditions.
理论依据
特发性肺动脉高压（IPAH）患者的人口统计学特征正在发生变化，且这一诊断在老年患者中越来越常见。然而，诊断错误分类很常见，因为区分IPAH和射血分数保留的心力衰竭所致肺动脉高压（PH-HFpEF）可能存在困难。我们研究了以下假设：毛细血管二氧化碳分压（pcCO2）可能有助于区分特发性肺动脉高压（IPAH）和射血分数保留的心力衰竭所致肺动脉高压（PH-HFpEF）。
方法
在一项横断面研究中，我们分别回顾性评估了IPAH或PH-HFpEF患者的pcCO2水平（在诊断时从动脉化毛细血管血中获取）。采用受试者工作特征（ROC）曲线来确定能最佳区分这两种情况的pcCO2水平。如果pcCO2值的阴性预测值>0.9以排除IPAH或PH-HFpEF，则认为其有帮助。
结果
该研究纳入了185例患者，其中99例为IPAH（女性占74%；年龄47±17岁；体重指数26±5kg/m2，平均肺动脉压53±12mmHg，肺动脉楔压8±3mmHg），86例为PH-HFpEF（女性占64%；年龄69±10岁；体重指数30±6kg/m2，平均肺动脉压47±10mmHg，肺动脉楔压21±5mmHg）。IPAH组诊断时的pcCO2为33±4mmHg，PH-HFpEF组为40±5mmHg（p < 0.001）。根据ROC分析，pcCO2为36mmHg是区分这两种疾病的最佳指标，曲线下面积为0.87（p < 0.001）。pcCO2 < 34mmHg的患者中PH-HFpEF的可能性<10%，而pcCO2 > 41mmHg的患者中IPAH的可能性<10%。
结论
与PH-HFpEF相比，IPAH患者的pcCO2水平显著更低，且可能为区分这两种情况提供有用信息。
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