Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Eur Respir J. 2018 Jan 18;51(1). doi: 10.1183/13993003.01311-2017. Print 2018 Jan.
Elevated mean pulmonary arterial pressure (MPAP; ≥21 mmHg) is sometimes seen in patients with idiopathic pulmonary fibrosis (IPF) and has an adverse impact upon survival. Although early diagnosis is crucial, there is no established screening tool that uses a combination of noninvasive examinations.We retrospectively analysed IPF patients at initial evaluation from April 2007 to July 2015 and, using logistic regression analysis, created a screening tool to identify elevated MPAP. Internal validation was also assessed for external validity using a bootstrap method.Using right-heart catheterisation (RHC), elevation of MPAP was determined to be present in 55 out of 273 patients. Multivariate models demonstrated that % predicted diffusing capacity of the lung for carbon monoxide () <50%, ratio of pulmonary artery diameter to aorta diameter (PA/Ao) on computed tomography (CT) ≥0.9 and arterial oxygen tension ( ) <80 Torr were independent predictors. When we assigned a single point to each variable, the prevalence of elevation of MPAP with a score of zero, one, two or three points was 6.7%, 16.0%, 29.1% and 65.4%, respectively. The area under curve (AUC) for the receiver operating characteristic (ROC) curve was good at 0.757 (95% CI 0.682-0.833).A simple clinical scoring system consisting of % predicted , PA/Ao ratio on CT and can easily predict elevation of MPAP in patients with IPF.
肺动脉平均压（MPAP；≥21mmHg）升高在特发性肺纤维化（IPF）患者中时有发生，对生存有不利影响。尽管早期诊断至关重要，但目前尚无使用非侵入性检查相结合的既定筛查工具。我们回顾性分析了 2007 年 4 月至 2015 年 7 月初次评估的 IPF 患者，并使用逻辑回归分析创建了一种筛查工具来识别升高的 MPAP。还使用自举法对内的有效性进行了外部有效性验证。使用右心导管检查（RHC）确定 273 例患者中有 55 例 MPAP 升高。多变量模型表明，预测弥散量的百分比 <50%（DLCO）、CT 上肺动脉直径与主动脉直径的比值（PA/Ao）≥0.9 和动脉氧分压（ ）<80Torr 是独立的预测因子。当我们为每个变量分配一个点时，MPAP 升高的患病率分别为 0 分、1 分、2 分和 3 分的 6.7%、16.0%、29.1%和 65.4%。ROC 曲线的曲线下面积（AUC）为 0.757（95%CI 0.682-0.833）。由预测值、CT 上的 PA/Ao 比值和 组成的简单临床评分系统可以方便地预测 IPF 患者 MPAP 的升高。
