Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie, Centre de référence des Histiocytoses, Hôpital Saint-Louis, 75475 Paris Cedex 10, France; Université Paris Cité, UFR de médecine, 75006 Paris, France.
Université de Lorraine, CHRU-Nancy, Pôle des spécialités médicales/département de pneumologie, F-54000 Nancy, France.
Respir Med Res. 2023 Jun;83:101008. doi: 10.1016/j.resmer.2023.101008. Epub 2023 Apr 21.
Pulmonary hypertension (PH) is a hemodynamic condition characterized by an abnormal elevation in pulmonary arterial pressures. Several pathophysiological pre-capillary and post-capillary mechanisms have been described. PH is a common complication of chronic obstructive pulmonary disease (COPD), however, the prevalence of each mechanism in the development of PH in patients with COPD has been hardly studied.
We reported the clinical, functional, hemodynamic characteristics and outcomes of patients diagnosed with COPD and PH among the expert PH center of Nancy between January 1, 2015 and March 31, 2021.
123 patients with COPD and PH were included. Most patients (n=122, 99%) had a pre-capillary mechanism, 9% (n=11) a post-capillary mechanism, and 1% (n=1) an unclassified mechanism. 111 (90%) patients had pure pre-capillary PH and 11 (9%) patients had combined pre- and post-capillary PH. Combined pre- and post-capillary PH group was characterized by higher prevalence of cardiovascular comorbidities and of sleep apnea-hypopnea syndrome, a higher body mass index, lower lung volumes, higher mean pulmonary arterial pressure, pulmonary arterial wedge pressure and right atrial pressure. At follow-up (median 30 months), 52 patients had died, and 11 had undergone lung transplantation. One-year, three-year and five-year transplant-free survival rates were 71%, 29% and 11% respectively. There was no difference on outcomes between groups.
PH in COPD patients is mostly due to pre-capillary mechanism. However, the existence of various and numerous comorbidities in COPD, especially cardiovascular, can lead to the participation of post-capillary mechanisms in the development of PH. Further studies are needed to confirm these findings and to assess the impact on outcomes and management strategies in these different patients.
肺动脉高压（PH）是一种以肺动脉压异常升高为特征的血流动力学状态。已经描述了几种前毛细血管和后毛细血管的病理生理机制。PH 是慢性阻塞性肺疾病（COPD）的常见并发症，然而，在 COPD 患者 PH 发展中每种机制的患病率几乎没有研究过。
我们报告了 2015 年 1 月 1 日至 2021 年 3 月 31 日期间在南希专家 PH 中心诊断为 COPD 和 PH 的患者的临床、功能、血流动力学特征和结局。
共纳入 123 例 COPD 合并 PH 患者。大多数患者（n=122，99%）存在前毛细血管机制，9%（n=11）存在后毛细血管机制，1%（n=1）存在未分类机制。111 例（90%）患者为单纯前毛细血管 PH，11 例（9%）患者为前-后毛细血管混合 PH。前-后毛细血管混合 PH 组心血管合并症和睡眠呼吸暂停低通气综合征的患病率较高，体质量指数较高，肺容积较低，平均肺动脉压、肺动脉楔压和右心房压较高。在随访（中位数 30 个月）期间，52 例患者死亡，11 例患者接受了肺移植。1 年、3 年和 5 年无移植生存率分别为 71%、29%和 11%。两组间结局无差异。
COPD 患者的 PH 主要是由于前毛细血管机制所致。然而，COPD 中存在各种和众多的合并症，特别是心血管合并症，可能导致后毛细血管机制参与 PH 的发生。需要进一步研究来证实这些发现，并评估这些不同患者对结局和管理策略的影响。
