Shi X, Yang G L, Chen Y, Guo J, Yang W L, Yuan P, Gong S G, Jiang R, Zhao Q H, Wang L, He J, Chen T X, Liu J M
Tongji University School of Medicine, Shanghai 200092, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2017 Jan 12;40(1):34-39. doi: 10.3760/cma.j.issn.1001-0939.2017.01.008.
To explore the difference in end tidal PCO(2) (P(ET)CO(2)) between idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH), and to analyze the correlation between P(ET)CO(2) and the indexes of disease severity in IPAH and CTEPH patients. Data were retrieved from 68 IPAH patients and 52 CTEPH patients who all had received right-heart catheterization, pulmonary function test and cardiopulmonary exercise testing at Shanghai Pulmonary Hospital from October 2011 to October 2014. In addition, other clinical parameters were also collected. The IPAH group had a significantly higher mPAP, PVR [(60±16) mmHg (1 mmHg=0.133 kPa), (13±6) Wood U ] than the CTEPH group [(46±12) mmHg, (9±4) Wood U, =4.90, 4.83, all <0.01]. Meanwhile, the IPAH group had a lower percentage of predicted peakVO(2), oxygen pulse [(45±15)%, (60±22)%] compared with the CTEPH group [(53±16)%, (68±21)%, =-2.42, -1.96, all <0.05]. The value of P(ET)CO(2) at rest, AT, peak in the IPAH patients [(27±5), (28±7), (25±7) mmHg] were higher than those in the CTEPH patients [(24±4) mmHg, (23±6) mmHg, (21±6) mmHg, =3.22-4.54, all <0.01]. There was a significantly difference in P(ET)CO(2) at AT and peak between WHO-FC Ⅰ-Ⅱ and Ⅲ-Ⅳ subgroups in IPAH (=2.55, 2.60, all <0.05) and CTEPH (=2.39, <0.05), except for P(ET)CO(2) at peak in the CTEPH patients (=1.71, >0.05). A moderately inverse correlation was found between P(ET)CO(2) at AT and NT-proBNP in the IPAH group (=-0.58, <0.01), meanwhile P(ET)CO(2) at AT in the CTEPH group was weakly correlated with NT-proBNP (=-0.34, <0.05). Compared with the CTEPH patients, the IPAH patients had significantly decreased exercise capacity and increased P(ET)CO(2). P(ET)CO(2) could reflect the disease severity in both IPAH and CTEPH patients, being superior in IPAH than in CTEPH. Furthermore, P(ET)CO(2) at AT might be better than P(ET)CO(2) at peak in reflecting the ventilatory efficiency.
探讨特发性肺动脉高压（IPAH）与慢性血栓栓塞性肺动脉高压（CTEPH）患者呼气末二氧化碳分压（P(ET)CO(2)）的差异，并分析IPAH和CTEPH患者中P(ET)CO(2)与疾病严重程度指标的相关性。收集2011年10月至2014年10月在上海肺科医院接受右心导管检查、肺功能测试和心肺运动试验的68例IPAH患者和52例CTEPH患者的数据。此外，还收集了其他临床参数。IPAH组平均肺动脉压（mPAP）、肺血管阻力（PVR）[（60±16）mmHg（1 mmHg = 0.133 kPa），（13±6）Wood U]显著高于CTEPH组[（46±12）mmHg，（9±4）Wood U，t = 4.90，4.83，均<0.01]。同时，IPAH组预测峰值摄氧量（peakVO(2)）、氧脉搏百分比[（45±15）%，（60±22）%]低于CTEPH组[（53±16）%，（68±21）%，t = -2.42，-1.96，均<0.05]。IPAH患者静息、运动中通气量增加（AT）、峰值时的P(ET)CO(2)值[（27±5）、（28±7）、（25±7）mmHg]高于CTEPH患者[（24±4）mmHg、（23±6）mmHg、（21±6）mmHg，t = 3.22 - 4.54，均<0.01]。IPAH患者WHO功能分级（WHO-FC）Ⅰ - Ⅱ级与Ⅲ - Ⅳ级亚组之间运动中通气量增加（AT）和峰值时的P(ET)CO(2)有显著差异（t = 2.55，2.60，均<0.05），CTEPH患者中除峰值时P(ET)CO(2)外（t = 1.71，>0.05）也有显著差异（t = 2.39，<0.05）。IPAH组运动中通气量增加（AT）时的P(ET)CO(2)与N末端脑钠肽前体（NT-proBNP）呈中度负相关（r = -0.58，<0.01），同时CTEPH组运动中通气量增加（AT）时的P(ET)CO(2)与NT-proBNP呈弱相关（r = -0.34，<0.05）。与CTEPH患者相比，IPAH患者运动能力显著下降，P(ET)CO(2)升高。P(ET)CO(2)可反映IPAH和CTEPH患者的疾病严重程度，在IPAH中比CTEPH中更具优势。此外，运动中通气量增加（AT）时的P(ET)CO(2)在反映通气效率方面可能优于峰值时的P(ET)CO(2)。
