背景:肺动脉高压(PH)是一种以肺动脉压异常升高为特征的血液动力学疾病。已经描述了几种病理生理学的毛细血管前和毛细血管后机制。PH是慢性阻塞性肺疾病(COPD)的常见并发症,然而,COPD患者中PH发生的每种机制的患病率几乎没有研究。
方法:我们报告了临床,功能,1月1日之间南希PH专家中心诊断为COPD和PH患者的血流动力学特征和预后,2015年3月31日,2021年。
结果:纳入了123例COPD和PH患者。大多数患者(n=122,99%)具有毛细血管前机制,9%(n=11)的后毛细管机制,1%(n=1)的机制未分类。111例(90%)患者患有纯毛细血管前PH,11例(9%)患者患有毛细血管前后PH。合并前和后毛细血管PH组的特征是心血管合并症和睡眠呼吸暂停低通气综合征的患病率较高,较高的体重指数,下肺容积,平均肺动脉压升高,肺动脉楔压和右心房压。随访时(中位数30个月),52名患者死亡,11人接受了肺移植。一年,三年和五年无移植生存率为71%,分别为29%和11%。组间结果无差异。
结论:COPD患者的PH主要是由于毛细血管前机制。然而,COPD中存在各种和众多的合并症,尤其是心血管疾病,可导致毛细血管后机制参与PH的发展。需要进一步的研究来证实这些发现,并评估这些不同患者对结果和管理策略的影响。
BACKGROUND: Pulmonary hypertension (PH) is a hemodynamic condition characterized by an abnormal elevation in pulmonary arterial pressures. Several pathophysiological pre-capillary and post-capillary mechanisms have been described. PH is a common complication of chronic obstructive pulmonary disease (COPD), however, the prevalence of each mechanism in the development of PH in patients with COPD has been hardly studied.
METHODS: We reported the clinical, functional, hemodynamic characteristics and outcomes of patients diagnosed with COPD and PH among the expert PH center of Nancy between January 1st, 2015 and March 31st, 2021.
RESULTS: 123 patients with COPD and PH were included. Most patients (n=122, 99%) had a pre-capillary mechanism, 9% (n=11) a post-capillary mechanism, and 1% (n=1) an unclassified mechanism. 111 (90%) patients had pure pre-capillary PH and 11 (9%) patients had combined pre- and post-capillary PH. Combined pre- and post-capillary PH group was characterized by higher prevalence of cardiovascular comorbidities and of sleep apnea-hypopnea syndrome, a higher body mass index, lower lung volumes, higher mean pulmonary arterial pressure, pulmonary arterial wedge pressure and right atrial pressure. At follow-up (median 30 months), 52 patients had died, and 11 had undergone lung transplantation. One-year, three-year and five-year transplant-free survival rates were 71%, 29% and 11% respectively. There was no difference on outcomes between groups.
CONCLUSIONS: PH in COPD patients is mostly due to pre-capillary mechanism. However, the existence of various and numerous comorbidities in COPD, especially cardiovascular, can lead to the participation of post-capillary mechanisms in the development of PH. Further studies are needed to confirm these findings and to assess the impact on outcomes and management strategies in these different patients.