Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation.
Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation.
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DOI：
10.1186/s12931-017-0568-z
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发表时间：
2017-05-06
影响因子：
5.8
通讯作者：
Roman A
中科院分区：
文献类型：
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作者：
Domingo E;Grignola JC;Aguilar R;Messeguer ML;Roman A
与肺部疾病相关的肺动脉高压(PH)是所有类型PH中预后最差的。肺血管病变是慢性阻塞性肺疾病(COPD)和间质性肺疾病(ILD)自然病程中的早期事件。本研究描述了接受肺移植(LTX)的COPD和ILD患者的肺动脉壁结构和功能的变化。73名患者，63名LTX前患者(30名COPD，33名ILD)和10名对照组同时接受了右心插管和血管内超声(IVUS)检查。测定肺总阻力(TPR)、肺电容(CP)及TPR-CP之间的关系。动脉硬度和壁厚相对面积分别用脉搏动脉压/静脉内膜搏动性和[(外截面面积-内膜面积)/外截面面积] × 100来估算。27%的患者有肺动脉楔压 &> 15毫米汞柱，没有进行分析。PA硬度和壁厚面积较对照组增加，即使在无PH组也是如此(p <； 0.0 5)。与慢性阻塞性肺疾病组比较，慢性阻塞性肺疾病组的平均动脉压以上压(MPAP)、平均动脉压外压(MPAP)和室壁厚度面积显著降低(p <； 0.0 5)。ILD患者TPR-CP关系左移。即使在没有PH的患者中，PA硬度和壁厚面积也明显增加，可以在LTX的PH-肺部疾病候选患者的临床前阶段诊断肺血管病变。相对于COPD，ILD患者表现出最差的PA僵硬和CP。
Pulmonary hypertension (PH) associated with lung disease has the worst prognosis of all types of PH. Pulmonary arterial vasculopathy is an early event in the natural history of chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). The present study characterized the alterations in the structure and function of the pulmonary arterial (PA) wall of COPD and ILD candidates for lung transplantation (LTx). A cohort of 73 patients, 63 pre-LTx (30 COPD, 33 ILD), and ten controls underwent simultaneous right heart catheterisation and intravascular ultrasound (IVUS). Total pulmonary resistance (TPR), capacitance (Cp), and the TPR-Cp relationship were assessed. PA stiffness and the relative area of wall thickness were estimated as pulse PA pressure/IVUS pulsatility and as [(external sectional area-intimal area)/external sectional area] × 100, respectively. Twenty-seven percent of patients had pulmonary arterial wedge pressure > 15 mmHg and were not analyzed. PA stiffness and the area of wall thickness were increased in comparison with controls, even in patients without PH (p < 0.05). ILD patients showed a significant higher PA stiffness, and lower Cp beyond mean PA pressure (mPAP) and lower area of wall thickness than COPD patients (p < 0.05). TPR-Cp relationship was shifted downward left for ILD patients. Significant increase of PA stiffness and area of wall thickness were present even in patients without PH and can make the diagnosis of pulmonary vasculopathy at a preclinical stage in PH-lung disease candidates for LTx. ILD patients showed the worst PA stiffness and Cp with respect to COPD.