Coste Florence, Benlala Ilyes, Dournes Gaël, Dromer Claire, Blanchard Elodie, Girodet Pierre-Olivier, Montaudon Michel, Baldacci Fabien, Picard François, Marthan Roger, Laurent François, Berger Patrick
Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France,
Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France,
Int J Chron Obstruct Pulmon Dis. 2019 Feb 11;14:381-389. doi: 10.2147/COPD.S177638. eCollection 2019.
Little is known about in vivo alterations at bronchial and vascular levels in severe pulmonary hypertension (PH) of different etiologies. We aimed to compare quantitative computed tomography (CT) data from the following three groups of severe precapillary PH patients: COPD, idiopathic pulmonary arterial hypertension (iPAH), and chronic thromboembolic PH (CTEPH).
This study was approved by the institutional review board. Severe PH patients (mean pulmonary arterial pressure [mPAP] ≥35 mmHg) with COPD, iPAH, or CTEPH (n=24, 16, or 16, respectively) were included retrospectively between January 2008 and January 2017. Univariate analysis of mPAP was performed in each severe PH group. Bronchial wall thickness (WT) and percentage of cross sectional area of pulmonary vessels less than 5 mm normalized by lung area (%CSA) were measured and compared using CT, and then combined to arterial partial pressure of oxygen (PaO) to generate a "paw score" compared within the three groups using Kruskal-Wallis and its sensitivity using Fisher's exact test.
WT was higher and %CSA was lower in the COPD group compared to iPAH and CTEPH groups. Mosaic pattern was higher in CTEPH group than in others. In severe PH patients secondary to COPD, mPAP was positively correlated to %CSA. By contrast, in severe iPAH, this correlation was negative, or not correlated in severe CTEPH groups. In the COPD group, "paw score" showed higher sensitivity than in the other two groups.
Unlike in severe iPAH and CTEPH, severe PH with COPD can be predicted by "paw score" reflecting bronchial and vascular morphological differential alterations.
对于不同病因的重度肺动脉高压（PH）患者支气管和血管水平的体内改变，我们知之甚少。我们旨在比较以下三组重度毛细血管前性PH患者的定量计算机断层扫描（CT）数据：慢性阻塞性肺疾病（COPD）、特发性肺动脉高压（iPAH）和慢性血栓栓塞性PH（CTEPH）。
本研究经机构审查委员会批准。回顾性纳入2008年1月至2017年1月期间患有COPD、iPAH或CTEPH的重度PH患者（平均肺动脉压[mPAP]≥35 mmHg），每组分别为24例、16例或16例。对每个重度PH组进行mPAP的单因素分析。使用CT测量并比较支气管壁厚度（WT）和肺血管横截面积小于5 mm且经肺面积标准化后的百分比（%CSA），然后将其与动脉血氧分压（PaO）相结合以生成“paw评分”，并使用Kruskal-Wallis检验在三组之间进行比较，以及使用Fisher精确检验比较其敏感性。
与iPAH组和CTEPH组相比，COPD组的WT更高，%CSA更低。CTEPH组的马赛克征比其他组更高。在继发于COPD的重度PH患者中，mPAP与%CSA呈正相关。相比之下，在重度iPAH中，这种相关性为负，在重度CTEPH组中则无相关性。在COPD组中，“paw评分”显示出比其他两组更高的敏感性。
与重度iPAH和CTEPH不同，反映支气管和血管形态学差异改变的“paw评分"可预测COPD合并的重度PH。
