混合静脉血氧分压是肺动脉高压的一个关键预后因素：一项回顾性队列研究。
Mixed venous oxygen tension is a crucial prognostic factor in pulmonary hypertension: a retrospective cohort study.
机构信息
Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan.
出版信息
BMC Pulm Med. 2022 Jul 20;22(1):282. doi: 10.1186/s12890-022-02073-0.
BACKGROUND
The prognostic value of mixed venous oxygen tension (PvO) at pulmonary hypertension diagnosis treated with selective pulmonary vasodilators remains unclear. This study sought to investigate the association of PvO with long-term prognosis in pulmonary arterial hypertension (PAH) and medically treated chronic thromboembolic pulmonary hypertension (CTEPH) and to identify the distinct mechanisms influencing tissue hypoxia in patients with CTEPH or PAH.
METHODS
We retrospectively analyzed data from 138 (age: 50.2 ± 16.6 years, 81.9% women) and 268 (age: 57.4 ± 13.1 years, 72.8% women) patients with PAH and CTEPH, respectively, diagnosed at our institution from 1983 to 2018. We analyzed the survival rates of patients with/without tissue hypoxia (PvO < 35 mmHg) and identified their prognostic factors based on the pulmonary hypertension risk stratification guidelines.
RESULTS
Survival was significantly poorer in patients with tissue hypoxia than in those without it for PAH (P = 0.001) and CTEPH (P = 0.017) treated with selective pulmonary vasodilators. In patients with PAH, PvO more strongly correlated with prognosis than other hemodynamic prognostic factors regardless of selective pulmonary vasodilators usage. PvO was the only significant prognostic factor in patients with CTEPH treated with pulmonary hypertension medication. Patients with CTEPH experiencing tissue hypoxia exhibited significantly poorer survival than those in the intervention group (P < 0.001). PvO more strongly correlated with the cardiac index (CI) than the alveolar-arterial oxygen gradient (A-aDO) in PAH; whereas in CTEPH, PvO was more strongly correlated with A-aDO than with CI.
CONCLUSIONS
PvO may represent a crucial prognostic factor for pulmonary hypertension. The prognostic impact of tissue hypoxia affects different aspects of PAH and CTEPH, thereby reflecting their distinct pathogenesis.
背景
在接受选择性肺动脉扩张剂治疗的肺动脉高压患者中，混合静脉血氧分压（PvO）的预后价值仍不清楚。本研究旨在探讨 PvO 与特发性肺动脉高压（PAH）和药物治疗的慢性血栓栓塞性肺动脉高压（CTEPH）患者的长期预后之间的关系，并确定影响 CTEPH 或 PAH 患者组织缺氧的不同机制。
方法
我们回顾性分析了 1983 年至 2018 年在我院诊断的 138 例（年龄：50.2±16.6 岁，81.9%为女性）和 268 例（年龄：57.4±13.1 岁，72.8%为女性）PAH 和 CTEPH 患者的数据。我们分析了有/无组织缺氧（PvO<35mmHg）患者的生存率，并根据肺动脉高压风险分层指南确定了其预后因素。
结果
与无组织缺氧患者相比，接受选择性肺动脉扩张剂治疗的 PAH（P=0.001）和 CTEPH（P=0.017）患者的生存时间明显更差。在接受肺动脉高压药物治疗的患者中，PvO 与预后的相关性强于其他血流动力学预后因素。PvO 是 CTEPH 患者接受肺动脉高压药物治疗的唯一重要预后因素。有组织缺氧的 CTEPH 患者的生存时间明显差于介入组（P<0.001）。在 PAH 中，PvO 与心脏指数（CI）的相关性强于肺泡-动脉血氧分压差（A-aDO）；而在 CTEPH 中，PvO 与 A-aDO 的相关性强于与 CI 的相关性。
结论
PvO 可能是肺动脉高压的一个重要预后因素。组织缺氧的预后影响影响到 PAH 和 CTEPH 的不同方面，从而反映了它们不同的发病机制。
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