School of Medical Science and Technology (SMST), Indian Institute of Technology Kharagpur, Kharagpur, 721302, India.
Institute of Pulmocare and Research, Kolkata, India.
Metabolomics. 2021 Oct 1;17(10):94. doi: 10.1007/s11306-021-01845-9.
Chronic obstructive pulmonary disease (COPD) associated pulmonary hypertension (COPD-PH), one of the most prevalent forms of PH, is a major burden on the healthcare system. Although PH in COPD is usually of mild-to-moderate severity, its presence is associated with shorter survival, more frequent exacerbations and worse clinical outcomes. The pathophysiologic mechanisms responsible for PH development in COPD patients remain unclear. It is envisioned that a better understanding of the underlying mechanism will help in diagnosis and future treatment strategies.
The present study aims to determine metabolomic alterations in COPD-PH patients as compared to healthy controls. Additionally, to ensure that the dysregulated metabolites arise due to the presence of PH per se, an independent COPD cohort is included for comparison purposes.
Paired serum and exhaled breath condensate (EBC) samples were collected from male patients with COPD-PH (n = 60) in accordance with the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines. Age, sex and BMI matched healthy controls (n = 57) and COPD patients (n = 59) were recruited for comparison purposes. All samples were characterized using H nuclear magnetic resonance (NMR) spectroscopy.
Fifteen serum and 9 EBC metabolites were found to be significantly altered in COPD-PH patients as compared to healthy controls. Lactate and pyruvate were dysregulated in both the biofluids and were further correlated with echocardiographic systolic pulmonary artery pressure (sPAP). Multivariate analysis showed distinct class separation between COPD-PH and COPD.
The findings of this study indicate an increased energy demand in patients with COPD-PH. Furthermore, both lactate and pyruvate correlate with sPAP, indicating their importance in the clinical course of the disease.
慢性阻塞性肺疾病（COPD）相关肺动脉高压（COPD-PH）是最常见的肺动脉高压（PH）类型之一，给医疗保健系统带来了巨大负担。尽管 COPD 中的 PH 通常为轻中度，但它的存在与较短的生存期、更频繁的恶化和更差的临床结局相关。导致 COPD 患者 PH 发展的病理生理机制仍不清楚。人们认为，更好地了解潜在机制将有助于诊断和未来的治疗策略。
本研究旨在确定 COPD-PH 患者与健康对照组之间的代谢组学改变。此外，为确保失调的代谢物是由于 PH 本身的存在而产生的，还纳入了一个独立的 COPD 队列进行比较。
根据 2015 年欧洲心脏病学会（ESC）/欧洲呼吸学会（ERS）指南，对男性 COPD-PH 患者（n=60）采集配对的血清和呼出气冷凝液（EBC）样本。招募年龄、性别和 BMI 匹配的健康对照者（n=57）和 COPD 患者（n=59）进行比较。所有样本均采用 H 核磁共振（NMR）光谱法进行特征描述。
与健康对照组相比，COPD-PH 患者的 15 种血清和 9 种 EBC 代谢物发生显著改变。乳酸和丙酮酸在两种生物流体中均失调，并且与超声心动图收缩期肺动脉压（sPAP）进一步相关。多变量分析显示 COPD-PH 和 COPD 之间存在明显的分类分离。
本研究的结果表明 COPD-PH 患者的能量需求增加。此外，乳酸和丙酮酸均与 sPAP 相关，表明它们在疾病的临床病程中很重要。
