慢性阻塞性肺疾病中肺循环的表现。海拔2240米时肺动脉高压的发病机制。

Behavior of the pulmonary circulation in chronic obstructive pulmonary disease. Pathogenesis of pulmonary arterial hypertension at an attitude of 2,240 meters.

作者信息

Lupi-Herrera E, Sandoval J, Seoane M, Bialostozky D

出版信息

Am Rev Respir Dis. 1982 Sep;126(3):509-14. doi: 10.1164/arrd.1982.126.3.509.

DOI:10.1164/arrd.1982.126.3.509

Abstract

The hemodynamics of the pulmonary circulation were examined in 28 patients with severe and stable chronic obstructive pulmonary disease (COPD) who were born and raised at high altitude (2,240 meters) (COPD-A). All patients had mean pulmonary pressures (PAP) greater than 16 mmHg. We observed: (1) a low correlation between pulmonary arterial diastolic pressure (PAd) and arterial oxygen saturation (r = 0.38, p less than 0.05); (2) similar PAP in patients with COPD living at sea level (COPD-S) and patients with COPD-A (COPD-S, 32 +/- 7 mmHg; COPD-A, 27.5 +/- 11 mmHg; p = NS), despite more unsaturation in patients with COPD-A (COPD-S, 84.6 +/- 6%; COPD-A, 77.5 +/- 9%; p less than 0.05) and similar arterial pH; (3) lower levels of PAP in COPD-A (COPD-S, 51.7 +/- 10 mmHg; COPD-A, 33.6 +/- 12 mmHg; p less than 0.001) for the same degree of unsaturation (COPD-S, 71 +/- 6%; COPD-A, 71 +/- 8%; p = NS) and a lower arterial pH in COPD-S (COPD-S, 7.34 +/- 0.03; COPD-A, 7.39 +/- 0.04; p less than 0.01). We conclude that pulmonary hypertension caused by chronic alveolar hypoxia is present in COPD-A, but it seems to be decreased when compared with that observed in COPD-S.

摘要

对28例出生并成长于高海拔地区（2240米）的重度稳定期慢性阻塞性肺疾病（COPD）患者（COPD-A组）的肺循环血流动力学进行了检查。所有患者的平均肺动脉压（PAP）均大于16 mmHg。我们观察到：（1）肺动脉舒张压（PAd）与动脉血氧饱和度之间的相关性较低（r = 0.38，p < 0.05）；（2）尽管COPD-A组患者的血氧饱和度更低（COPD-S组，84.6±6%；COPD-A组，77.5±9%；p < 0.05）且动脉pH值相似，但海平面居住的COPD患者（COPD-S组）和COPD-A组患者的PAP相似（COPD-S组，32±7 mmHg；COPD-A组，27.5±11 mmHg；p = 无显著性差异）；（3）在相同程度的血氧饱和度情况下（COPD-S组，71±6%；COPD-A组，71±8%；p = 无显著性差异），COPD-A组的PAP水平更低（COPD-S组，51.7±10 mmHg；COPD-A组，33.6±12 mmHg；p < 0.001），且COPD-S组的动脉pH值更低（COPD-S组，7.34±0.03；COPD-A组，7.39±0.04；p < 0.01）。我们得出结论，COPD-A组存在慢性肺泡缺氧所致的肺动脉高压，但与COPD-S组相比，其似乎有所降低。