Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
Respir Investig. 2021 May;59(3):342-349. doi: 10.1016/j.resinv.2020.12.010. Epub 2021 Feb 10.
Pulmonary hypertension (PH) influences mortality in patients with interstitial lung disease (ILD). Almost all studies on patients with ILD, have focused on the clinical impact of pre-capillary PH on survival. Therefore, little is known about the influence of post-capillary PH. We aimed to assess the prevalence of post-capillary PH and its clinical impact on survival in patients with ILD, followed by comparison with pre-capillary PH.
This retrospective study enrolled 1152 patients with ILD who were diagnosed with PH using right heart catheterization between May 2007 and December 2015. We analyzed the demographics and composite outcomes (defined as death from any cause or lung transplantation) of patients with post-capillary PH and compared them with patients with pre-capillary PH.
Thirty-two (20%) of the 157 patients with ILD-PH were diagnosed with post-capillary PH. Patients with post-capillary PH had significantly lower modified Medical Research Council scores, higher diffusion capacity for carbon monoxide, higher resting PaO, lower pulmonary vascular resistance (PVR), and higher lowest oxygen saturation during the 6-min walk test compared to those with pre-capillary PH. Cardiovascular diseases were associated with a higher risk of mortality in patients with post-capillary PH. Multivariate Cox proportional hazards analysis demonstrated no significant difference between the composite outcomes in pre-capillary and post-capillary PH, while PVR and the ILD Gender-Age-Physiology Index were significantly associated with the composite outcome.
We found that approximately one-fifth of patients with ILD-PH were diagnosed with post-capillary PH, and that PVR and not post-capillary PH was associated with mortality.
肺动脉高压（PH）影响间质性肺疾病（ILD）患者的死亡率。几乎所有关于ILD 患者的研究都集中在毛细血管前 PH 对生存的临床影响上。因此，关于毛细血管后 PH 的影响知之甚少。我们旨在评估 ILD 患者中毛细血管后 PH 的患病率及其对生存的临床影响，并与毛细血管前 PH 进行比较。
这项回顾性研究纳入了 2007 年 5 月至 2015 年 12 月期间通过右心导管检查诊断为 PH 的 1152 例 ILD 患者。我们分析了毛细血管后 PH 患者的人口统计学特征和复合结局（定义为任何原因导致的死亡或肺移植），并将其与毛细血管前 PH 患者进行了比较。
在 157 例 ILD-PH 患者中，有 32 例（20%）被诊断为毛细血管后 PH。与毛细血管前 PH 患者相比，毛细血管后 PH 患者的改良医学研究理事会评分明显较低，一氧化碳弥散量较高，静息 PaO 较高，肺血管阻力（PVR）较低，6 分钟步行试验中最低血氧饱和度较高。心血管疾病与毛细血管后 PH 患者的死亡风险增加相关。多变量 Cox 比例风险分析表明，毛细血管前和毛细血管后 PH 的复合结局之间无显著差异，而 PVR 和 ILD 性别-年龄-生理指数与复合结局显著相关。
我们发现，大约五分之一的 ILD-PH 患者被诊断为毛细血管后 PH，并且与死亡率相关的是 PVR，而不是毛细血管后 PH。
