Categorization and impact of pulmonary hypertension in patients with advanced COPD
Categorization and impact of pulmonary hypertension in patients with advanced COPD
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DOI：
10.1016/j.rmed.2010.05.009
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发表时间：
2010-12-01
影响因子：
4.3
通讯作者：
Nathan, Steven D.
中科院分区：
文献类型：
--
作者：
Cuttica, Michael J.;Kalhan, Ravi;Nathan, Steven D.
本研究的目的是明确肺高压在重症COPD患者中的患病率、严重程度和相关的功能影响。方法回顾1997-2006年间器官采购和组织网络(OPTN)数据库中初步诊断为COPD的患者的器官采购和组织网络(OPTN)数据库，对基线演示图形、血流动力学肺功能测试、6分钟步行试验(6MWD)和移植前生存资料进行分析。合并肺静脉高压者占17.2%，血流动力学正常者平均步行28m，PH值为238±106m，血流动力学正常组为261±104m(p<；在多变量分析中，平均肺动脉压(β=-1.33，p=0.01)、用力肺活量(β=1.48，p<；0001)和患者年龄(β=-1.91，p<；)是6MWD减少的独立预测因子。Ph(HR 1 23 95%CI[1 01-1 50])和PVH(HR 1 35 95%CI[1 11-1 65])被证明是候补名单上死亡的独立危险因素，即使在调整了年龄、性别、种族、BMI、肺功能、70岁的疾病和糖尿病(PH HR 1 27，95%CI[1 04-1 55]，PVH HR 140，95%CI[1 13-1 73]结论PH在晚期COPD中很常见，并与功能损害和死亡风险分层有关，RHC测定的肺血流动力学在区分不同的临床表型方面具有重要意义(C)2010 Elsevier Ltd保留所有权利
Introduction The functional significance of pulmonary hypertension (PH) in COPD is unclear The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung tran,plantMethods A retrospective review of the Organ Procurement and Tissue Network (OPTN) data base between 1997 and 2006 for patients with the primary diagnosis of COPD Baseline demo graphics, hemodynamics pulmonary function tests, six minute walk distance test (6MWD) and pre transplant survival data was analyzedResults 4930 patients with COPD had evaluable right heart catheterization data (RHC) PH was present in 30 4%, with pulmonary venous hypertension (PVH) accounting for an additional 17 2% of patients Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics Normal hemodynamics group 261 +/- 104 m, PH, 238 +/- 106 m (p < 0 01), PVH 228 +/- 104 m (p < 0 05) In a multivariable analysis, the mean pulmonary artery pressure (beta = -1 33, p = 0 01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (beta = 1 48, p < 0 001) and patient age (beta = -1 91, p < 0 001) Both PH (HR 1 23 95%CI [1 01-1 50]) and PVH (HR 1 35 95%CI [1 11-1 65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, seventy of illness and diabetes (PH HR 1 27, 95%CI [1 04-1 55], PVH HR 1 40, 95%CI [1 13-1 73])Conclusion PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes (C) 2010 Elsevier Ltd All rights reserved