Farkouh Claire, Chaouat Ari, Guillaumot Anne, Baptista Bruno Ribeiro, Chabot François, Valentin Simon
Département de Pneumologie, CHRU Nancy, Vandoeuvre-Lès Nancy, France.
Département de Pneumologie, CHRU Nancy, Vandoeuvre-Lès Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France.
Respir Med Res. 2025 May;87:101153. doi: 10.1016/j.resmer.2024.101153. Epub 2024 Dec 18.
Pulmonary hypertension (PH) is common during chronic obstructive pulmonary disease (COPD), particularly in patients with severe COPD. These patients can be classified into different PH groups due to frequent comorbidities. Emphysema is often associated with COPD and is responsible for lung hyperinflation, which may contribute to the development of PH. The treatment of PH in COPD is not well defined, and the response to treatment is variable depending on the phenotype of the patients. The aim of this study was to determine whether pulmonary hyperinflation in COPD patients predicts response to treatment.
This observational, retrospective, single-center study included COPD patients diagnosed with PH, treated with PH treatments. Patient were divided into two groups according to lung hyperinflation, judged on the ratio of residual volume to total lung capacity. Response to treatment was defined by an improvement of at least 30 m in the 6-minute walk test or a one-point improvement in World Health Organization functional class at the first reassessment performed at least three months after treatment initiation.
Of the 47 patients included, 30 (63.8 %) were responders to PH treatments, with no significant difference between patients in the "lung hyperinflation" (HI) group and those in the "no lung hyperinflation" (NoHI) group (64.3 % vs. 63.2 %, p = 0.937). However, response to treatment was significantly lower in the most distended patients when compared to non-distended patients (p = 0.033). Mean overall survival was 59.1 months (95 % CI [47.4-70.7]) and was significantly better in responders, with a mean survival of 71.5 months (95 % CI [58.6-84.5]) vs. 35.4 months (95 % CI [17.3-53.4], p = 0.001). Mean survival did not differ according to lung hyperinflation, with a mean survival of 50.3 months (95 % CI [35.2-65.3]) for patients with HI, and 70.4 months (95 % CI [54.3-86.5], p = 0.105) for NoHI patients.
In COPD and PH patients eligible for PH treatments, the presence of lung hyperinflation did not predict response to treatment. However, patients with high degree of lung hyperinflation had a significantly poorer response to PAH treatment than patients without lung hyperinflation. Further studies are needed to confirm these results and to investigate other determinants of response in this population.
The study design has been registered on ClinicalTrials (NCT06613321).
肺动脉高压（PH）在慢性阻塞性肺疾病（COPD）中很常见，尤其是在重度COPD患者中。由于频繁合并症，这些患者可分为不同的PH组。肺气肿常与COPD相关，是导致肺过度充气的原因，这可能促使PH的发展。COPD中PH的治疗尚不明确，治疗反应因患者表型而异。本研究的目的是确定COPD患者的肺过度充气是否可预测治疗反应。
这项观察性、回顾性、单中心研究纳入了诊断为PH并接受PH治疗的COPD患者。根据残气量与肺总量的比值判断肺过度充气情况，将患者分为两组。治疗反应定义为在治疗开始至少三个月后进行的首次重新评估时，6分钟步行试验至少改善30米或世界卫生组织功能分级提高1分。
纳入的47例患者中，30例（63.8%）对PH治疗有反应，“肺过度充气”（HI）组和“无肺过度充气”（NoHI）组患者之间无显著差异（64.3%对63.2%，p = 0.937）。然而，与未扩张患者相比，扩张最严重的患者治疗反应明显较低（p = 0.033）。平均总生存期为59.1个月（95%CI[47.4 - 70.7]），有反应者的生存期明显更长，平均生存期为71.5个月（95%CI[58.6 - 84.5]），而无反应者为35.4个月（95%CI[17.3 - 53.4]，p = 0.001）。根据肺过度充气情况，平均生存期无差异，HI患者的平均生存期为50.3个月（95%CI[35.2 - 65.3]），NoHI患者为70.4个月（95%CI[54.3 - 86.5]，p = 0.105）。
在符合PH治疗条件的COPD和PH患者中，肺过度充气的存在并不能预测治疗反应。然而，与无肺过度充气的患者相比，肺过度充气程度高的患者对PAH治疗的反应明显较差。需要进一步研究来证实这些结果，并调查该人群中其他治疗反应的决定因素。
该研究设计已在ClinicalTrials（NCT06613321）上注册。
