Clinical predictors of pulmonary hypertension in sarcoidosis
Clinical predictors of pulmonary hypertension in sarcoidosis
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DOI：
10.1183/09031936.00175907
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发表时间：
2008-08-01
影响因子：
24.3
通讯作者：
Samavati, I.
中科院分区：
文献类型：
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作者：
Bourbonnais, J. M.;Samavati, I.
肺动脉高压（PH）对结节病的预后有不利影响，是结节病患者死亡率的重要预测因子。早期和准确的诊断可以改善预后。目前的作者假设，将6分钟步行测试（6MWT）作为评估的一部分，可以更早地诊断出这种并发症。162例结节病患者行6MWT。对人口统计学和肺功能结果进行分析。当临床指征时，患者通过超声心动图和右心导管进一步评估。结节病相关PH患者的肺功能测试结果明显降低。他们也会走更短的距离，并在6MWT的水平下去饱和。在logistic回归分析中，PH的显著预测因子为6MWT的氧饱和度< 90%（比值比（OR） 12.1, 95%可信区间（CI） 3.66 ~ 19.73）和预测的肺弥散能力< 60% （OR 7.3, 95% Cl 1.98 ~ 24.82）。此外，通过将6min时的血氧饱和度结果与超声心动图结果相结合，可以提高右心导管正确预测PH存在的能力。在6分钟步行试验中，肺弥散量预测值< 60%，氧去饱和值< 90%的患者极有可能出现肺动脉高压，应进一步评估是否存在这种疾病。
Pulmonary hypertension (PH) adversely affects outcome in sarcoidosis and is an important predictor of mortality in these patients. Early and accurate diagnosis of this complication may improve outcome. The current authors hypothesised that integration of 6-min walk test (6MWT) as part of the evaluation leads to an earlier diagnosis of this complication. A total of 162 patients with sarcoidosis underwent 6MWT. Demographic and pulmonary function results were analysed. Patients were further assessed by echocardiography and right heart catheterisation when clinically indicated. Patients with sarcoidosis-associated PH had significantly decreased results on pulmonary function testing. They also walked shorter distances and desaturated to lower levels on 6MWT. On logistic regression analyses, significant predictors of PH were oxygen saturation < 90% on 6MWT (odds ratio (OR) 12.1, 95% confidence interval (CI) 3.66-19.73) and diffusing capacity of the lung for carbon monoxide < 60% predicted (OR 7.3, 95% Cl 1.98-24.82). Moreover, by combining the results of oxygen saturation at 6 min with those of echocardiography, the ability to correctly predict the presence of PH by right heart catheterisation was improved. Patients with diffusing capacity of the lung for carbon monoxide < 60% predicted and oxygen desaturation < 90% on 6-min walk test have a high likelihood of pulmonary hypertension and should undergo further evaluation for the presence of this disorder.