Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Medical Mission Hospital, Salvatorstrasse 7, 97074, Würzburg, Germany.
Medical Clinic I, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany.
Lung. 2017 Dec;195(6):759-768. doi: 10.1007/s00408-017-0052-z. Epub 2017 Oct 9.
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking.
A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension.
Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both "mental health" (p = 0.01) and "mental component summary score" (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups.
While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.
肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）是危及生命的疾病，其症状负担沉重。尽管也有报道称存在抑郁、焦虑和健康相关生活质量（HRQOL）下降，但缺乏对这些特征及其潜在因素的比较分析。
采用医院焦虑和抑郁量表（HADS）以及 SF-36 HRQOL 问卷对德国一家专门治疗肺动脉高压的三级保健中心的 70 名 PAH 和 23 名 CTEPH 门诊患者进行了抑郁、焦虑和健康相关 QOL 的回顾性分析。将这些工具的结果与血液动力学和功能参数进行比较。
尽管两个患者组的 HRQOL 均降低，但 CTEPH 患者在几乎所有 SF-36 参数中的得分均较低。在“心理健康”（p=0.01）和“心理成分综合评分”（MCS）（p=0.02）方面均具有显著意义。与 PAH 患者（30%）相比，CTEPH 患者的抑郁更为常见（56%）（p=0.03）。总体而言，在 PAH 和 CTEPH 中，抑郁和焦虑与大多数 SF-36 量表相关。在 CTEPH 中，抑郁与 Borg 呼吸困难量表（r=0.44，p=0.01）也相关。这些患者的 pCO 水平也显著低于 PAH 组，反映出更严重的通气/灌注不匹配。所有其他血液动力学和功能参数在两组之间无差异。
尽管两个患者组的 HRQOL 以及抑郁和焦虑均下降，但 CTEPH 组的心理健康参数下降更为明显。这表明应大力加强早期检测，尤其是在有 CTEPH 和 PAH 经典危险因素的呼吸困难患者中，应加强对这些患者的精神疾病干预，同时对 PAH 或 CTEPH 患者进行常规临床护理。
