系统性硬化症中运动诱发性肺动脉高压与甲襞毛细血管密度的关联：一项单中心回顾性观察研究
Association of exercise-induced pulmonary hypertension with nailfold capillary density in systemic sclerosis: a single-center retrospective observational study.
作者信息
Kusaka Katsuhide, Kubo Satoshi, Nakayamada Shingo, Miyagawa Ippei, Miyazaki Yusuke, Kanda Yurie, Todoroki Yasuyuki, Ueno Masanobu, Kanda Ryuichiro, Setoyama Koshi, Kataoka Masaharu, Tanaka Yoshiya
机构信息
First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-nishi, Kitakyushu, 807-8555, Japan.
Department of Molecular Targeted Therapeutics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-nishi, Kitakyushu, 807-8555, Japan.
出版信息
Arthritis Res Ther. 2025 Aug 26;27(1):169. doi: 10.1186/s13075-025-03633-5.
OBJECTIVES
Exercise-induced pulmonary hypertension (exercise PH) is instrumental in the early detection of pulmonary arterial hypertension. However, the prevalence and specific characteristics of exercise PH in systemic sclerosis (SSc), as well as factors that might facilitate its identification, remain inadequately understood. We investigated the clinical profiles of SSc patients diagnosed as PH, exercise PH, or non-PH.
METHODS
This study included 50 patients with SSc and exercise intolerance. We compared the physical examination findings, biochemistry tests, echocardiography, respiratory function tests, and resting and exercise right heart catheterization outcomes of the PH, exercise PH, or non-PH groups.
RESULTS
In a cohort of 50 patients with SSc and exercise intolerance, 30.0% were diagnosed with PH, and 44.0% exhibited exercise PH. Symptoms such as exertional dyspnea and palpitations were more prevalent in the exercise PH group compared to the non-PH group. Furthermore, a lower nailfold capillary density was observed in the exericse PH group. However, there was no difference between the two groups in terms of NT-proBNP level, serum uric acid, inflammatory findings, %DLco%, FVC/%DLco ratio, six-minute walking distance, or peak tricuspid regurgitant velocity. exercise PH was detected in 87.5% of patients presented all with exertional dyspnoea, exertional palpitations, and capillary density ≤ 7/mm. In many patients within the exercise PH group, the pulmonary artery wedge pressure/cardiac output slope exceeded 2 mmHg/L/min, indicating latent heart failure with preserved ejection fraction (HFpEF).
CONCLUSION
In our study, 44.0% of patients with SSc and exercise intolerance exhibited exercise PH, with many potentially having HFpEF. Decreased nailfold capillary density, exertional dyspnea, and palpitations were indicative markers useful for exercise PH screening.
目的
运动诱发性肺动脉高压（运动性肺动脉高压）有助于肺动脉高压的早期检测。然而，系统性硬化症（SSc）中运动性肺动脉高压的患病率和具体特征，以及可能有助于其识别的因素，仍未得到充分了解。我们调查了被诊断为肺动脉高压、运动性肺动脉高压或非肺动脉高压的SSc患者的临床特征。
方法
本研究纳入了50例有运动不耐受的SSc患者。我们比较了肺动脉高压组、运动性肺动脉高压组或非肺动脉高压组的体格检查结果、生化检查、超声心动图、呼吸功能测试以及静息和运动时右心导管检查结果。
结果
在50例有运动不耐受的SSc患者队列中，30.0%被诊断为肺动脉高压，44.0%表现为运动性肺动脉高压。与非肺动脉高压组相比，运动性肺动脉高压组中劳力性呼吸困难和心悸等症状更为普遍。此外，运动性肺动脉高压组观察到较低的甲襞毛细血管密度。然而，两组在N末端脑钠肽前体水平、血清尿酸、炎症指标、一氧化碳弥散量百分比、用力肺活量/一氧化碳弥散量比值、6分钟步行距离或三尖瓣反流峰值速度方面没有差异。在所有出现劳力性呼吸困难、劳力性心悸且毛细血管密度≤7/mm的患者中，87.5%检测到运动性肺动脉高压。在运动性肺动脉高压组的许多患者中，肺动脉楔压/心输出量斜率超过2 mmHg/L/min，表明存在射血分数保留的潜在心力衰竭（HFpEF）。
结论
在我们的研究中，44.0%有运动不耐受的SSc患者表现为运动性肺动脉高压，其中许多人可能患有HFpEF。甲襞毛细血管密度降低、劳力性呼吸困难和心悸是有助于运动性肺动脉高压筛查的指示性标志物。
Zotero 插件