Nocturnal Hypoxemia and High Circulating TNF-α Levels in Chronic Thromboembolic Pulmonary Hypertension
Nocturnal Hypoxemia and High Circulating TNF-α Levels in Chronic Thromboembolic Pulmonary Hypertension
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DOI：
10.2169/internalmedicine.4458-20
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发表时间：
2020-01-01
影响因子：
1.2
通讯作者：
Tatsumi, Koichiro
中科院分区：
文献类型：
--
作者：
Naito, Akira;Sakao, Seiichiro;Tatsumi, Koichiro
目的慢性血栓栓塞性肺动脉高压（CTEPH）是由肺动脉持续血栓栓塞引起的肺动脉高压，炎症可能是其病因之一。据报道，睡眠呼吸障碍（SDB）是肺动脉高压的重要并发症。然而，SDB与CTEPH炎症之间的关系尚未确定。本前瞻性观察性研究分析了SDB严重程度、肺血流动力学参数和CTEPH.Methods患者全身炎症水平之间的相关性。CTEPH患者于2017年11月至2019年6月在千叶大学医院肺动脉高压中心连续入组接受右心导管（RHC）检查。特发性肺动脉高压（IPAH）患者也作为对照组入组。结果CTEPH患者夜间低氧血症、氧减饱和指数（ODI）、呼吸暂停低通气指数（APH）均较IPAH患者严重。在这些因素中，只有夜间平均经皮血氧饱和度（SpO（2））与肺血流动力学参数呈负相关。CTEPH组循环肿瘤坏死因子-α（TNF-α）水平也较高，多因素分析显示夜间平均SpO（2）是高TNF-α水平的最重要预测因子。结论CTEPH患者血清TNF-α水平较高，夜间平均SpO（2）是血清TNF-α水平的预测因子。对夜间低氧血症和TNF-α水平的进一步研究可能为CTEPH的病因学和新的治疗策略提供新的见解。
Objective Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension caused by persistent thromboemboli of the pulmonary arteries, and one of its etiological factors may be inflammation. Sleep disordered breathing (SDB) is reportedly an important complication of pulmonary hypertension. However, the association between SDB and inflammation in CTEPH has been undefined. This prospective observational study analyzed the association between the severity of SDB, pulmonary hemodynamic parameters and the systemic inflammation level in patients with CTEPH.Methods CTEPH patients admitted for a right heart catheter (RHC) examination were consecutively enrolled from November 2017 to June 2019 at the pulmonary hypertension center in Chiba University Hospital. Patients with idiopathic pulmonary arterial hypertension (IPAH) were also enrolled as a control group. All patients underwent a sleep study using a WatchPAT 200 during admission.Results The CTEPH patients showed worse nocturnal hypoxemia, oxygen desaturation index (ODI), and apnea-hypopnea index than the IPAH patients. Among these factors, only the nocturnal mean percutaneous oxygen saturation (SpO(2)) was negatively correlated with the pulmonary hemodynamic parameters. The circulating tumor necrosis factor-alpha (TNF-alpha) level was also high in the CTEPH group, and a multivariate analysis showed that the nocturnal mean SpO(2) was the most important predictive factor for a high TNF-alpha level.Conclusion We showed that CTEPH patients had high serum TNF-alpha levels and that the nocturnal mean SpO(2) was a predictive factor for serum TNF-alpha levels. Further investigations focused on nocturnal hypoxemia and the TNF-alpha level may provide novel insight into the etiology and new therapeutic strategies for CTEPH.