Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease
Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease
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DOI：
10.1016/j.healun.2011.11.020
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发表时间：
2012-04-01
影响因子：
8.9
通讯作者：
Carlsen, Jorn
中科院分区：
文献类型：
--
作者：
Andersen, Kasper Hasseriis;Iversen, Martin;Carlsen, Jorn
背景：终末期慢性阻塞性肺疾病 (COPD) 患者中经右心导管插入术 (RHC) 诊断的肺动脉高压 (PH) 的存在和程度的患病率、预后重要性以及预测其存在和程度的因素仍不清楚。方法：这项回顾性研究纳入了 409 名患有 COPD/肺气肿或 α-I-抗胰蛋白酶缺乏症的患者（61% 女性），这些患者在 1991 年至 2010 年间接受了肺移植评估。我们分析了肺动脉高压 (PH) 的发生和程度。 PH 并比较了患有和不患有 PH 的患者的人口统计学、氧合、肺功能、血流动力学、功能能力和生存率。使用单变量和多变量回归分析评估 PH 的预测。结果：评估时的平均年龄为 54 +/- 7 岁。所有患者均处于纽约心脏协会功能分级 III-IV 级，1 秒用力呼气量为预测值的 23% +/- 7%，总肺活量为预测值的 126% +/- 21%。 146 人（36%）存在 PH。该分析排除了 53 名 (13%) 患有肺静脉高压 (PVH) 的患者。患有或不患有 PH 的患者的平均肺动脉压 (mPAP) 分布呈单峰正态分布群体，平均值为 23.8 +/- 6.0 mm Hg。 PH 的预测因子是氧分压和二氧化碳分压。患有 PH 的 COPD 患者的 5 年生存率为 37%，而无 PH 的患者的 5 年生存率为 63%（p = 0.016）。肺移植后的生存率没有差异 (p = 0.37)。结论：RHC 证实 36% 的 COPD 患者存在 PH。低氧血症和高碳酸血症与 mPAP 相关。 PH 与 COPD 患者较差的生存率相关，但 PH 不影响肺移植后的预后。 J Heart Lung Transplant 2012；31:373-80 (C) 2012 国际心肺移植学会。版权所有。
BACKGROUND: The prevalence, prognostic importance, and factors that predict the presence and degree of pulmonary hypertension (PH) diagnosed with right heart catheterization (RHC) in patients with end-stage chronic obstructive pulmonary disease (COPD) remain unclear.METHODS: This retrospective study included 409 patients (61% women) with COPD/emphysema or a-I-antitrypsin deficiency who underwent lung transplant evaluation during 1991 to 2010. We analyzed the occurrence and degree of PH and compared demographics, oxygenation, lung function, hemodynamics, functional capacity, and survival in patients with and without PH. Prediction of PH was assessed using univariate and multivariate regression analysis.RESULTS: The mean age at evaluation was 54 +/- 7 years. All patients were in New York Heart Association functional class III-IV, with forced expiratory volume in 1 second of 23% +/- 7% and total lung capacity of 126% +/- 21% of predicted. PH was present in 146 (36%). The analysis excluded 53 (13%) with pulmonary venous hypertension (PVH). The distribution of the mean pulmonary artery pressure (mPAP) in patients with or without PH showed a unimodal normally distributed population, with a mean of 23.8 +/- 6.0 mm Hg. Predictors of PH were partial pressures of oxygen and carbon dioxide. The 5-year survival rate was 37% in COPD patients with PH vs 63% in patients without PH (p = 0.016). Survival after lung transplantation did not differ (p = 0.37).CONCLUSIONS: RHC verified PH in 36% of COPD patients. Hypoxemia and hypercapnia were associated with mPAP. PH is associated with worse survival in COPD, but PH does not influence the prognosis after lung transplantation. J Heart Lung Transplant 2012;31:373-80 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.