Kamenskaya Oksana, Loginova Irina, Chernyavskiy Alexander, Edemskiy Aleksander, Lomivorotov Vladimir V, Karaskov Aleksander
Department of Physiology, Siberian Biomedical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya Street, Novosibirsk 630055, Russia.
Department of Cardiac Surgery, Siberian Biomedical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya Street, Novosibirsk 630055, Russia.
Clin Respir J. 2018 Jul;12(7):2242-2248. doi: 10.1111/crj.12898. Epub 2018 Apr 30.
The aim of our study was to investigate the prevalence of chronic obstructive pulmonary disease (COPD) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and examine their impact on the results of pulmonary thrombendarterectomy (PEA).
We enrolled 136 patients with CTEPH who scheduled for elective PEA. Pulmonary function tests (PFTs) including full-body plethysmography with bronchodilation test and lung diffusion capacity assessment were performed in all patients prior to surgery treatment. The diagnosis of COPD was verified in accordance with the recommendations of the Global Initiative for Chronic Obstructive Lung Disease 2017. The effect of COPD on perioperative characteristics, complications, in-hospital and one-year mortality of patients with CTEPH were analysed.
In the study group with CTEPH the prevalence of COPD was 23%. In 13% of patients, COPD was first detected. The results of PFTs showed more severe airflow limitations with obstructive pattern in patients with concomitant COPD, as well as a more pronounced decrease in the lung diffusion capacity. The presence of COPD in patients with CTEPH significantly increases the risk of residual pulmonary hypertension in the early postoperative period of PEA (OR = 6.2 (1.90-10.27), P = .002), duration of hospital stay (OR = 1.1 (1.01-1.20), P = .020) and the risk of in-hospital mortality (OR = 4.4 (1.21-16.19), P = .023). The lung diffusion capacity revealed significant negative associations with the duration of hospital stay and in-hospital mortality (OR 0.87 (0.74-0.98), P = .012).
COPD in patients with CTEPH significantly increases the risk of residual pulmonary hypertension, in-hospital mortality and increases the duration of hospital stay after PEA.
本研究旨在调查慢性血栓栓塞性肺动脉高压（CTEPH）患者中慢性阻塞性肺疾病（COPD）的患病率，并探讨其对肺动脉血栓内膜剥脱术（PEA）结果的影响。
我们纳入了136例计划接受择期PEA的CTEPH患者。所有患者在手术治疗前均进行了肺功能测试（PFTs），包括带支气管扩张试验的全身体积描记法和肺弥散功能评估。COPD的诊断根据慢性阻塞性肺疾病全球倡议2017的建议进行核实。分析了COPD对CTEPH患者围手术期特征、并发症、住院及1年死亡率的影响。
在CTEPH研究组中，COPD的患病率为23%。13%的患者首次检测出COPD。PFTs结果显示，合并COPD的患者气流受限更严重，呈阻塞性模式，肺弥散功能下降也更明显。CTEPH患者中COPD的存在显著增加了PEA术后早期残余肺动脉高压的风险（OR = 6.2（1.90 - 10.27），P = 0.002）、住院时间（OR = 1.1（1.01 - 1.20），P = 0.020）和住院死亡率（OR = 4.4（1.21 - 16.19），P = 0.023）。肺弥散功能与住院时间和住院死亡率呈显著负相关（OR 0.87（0.74 - 0.98），P = 0.012）。
CTEPH患者中的COPD显著增加了残余肺动脉高压、住院死亡率的风险，并延长了PEA术后的住院时间。
