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特发性肺动脉高压号慢性血栓栓塞性肺动脉高压小气道功能差异的研究

Peripheral small airway dysfunction differences between idiopathic pulmonary arterialhypertension and chronic thromboembolic pulmonary hypertension
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摘要 目的比较特发性肺动脉高压(IPAH)及慢性血栓栓塞性肺动脉高压(CTEPH)患者的小气道功能差异。方法回顾性纳入2015年11月至2017年11月上海市肺科医院肺循环科确诊为肺动脉高压的患者89例,其中IPAH患者42例(IPAH组),其中男18例,女29例,年龄26~73岁,平均(46±16)岁;CTEPH患者47例(CTEPH组),其中男13例,女29例,年龄22~80岁,平均(61±13)岁;同期30名健康体检者作为对照组,其中男12名,女18名,年龄24~59岁,平均(54±6)岁。所有患者均进行常规肺功能及脉冲振荡肺功能(IOS)检查,分析IPAH与CTEPH患者肺功能小气道变化特点,并比较合并其他气道疾病对小气道功能的影响。结果与IPAH组比较,CTEPH组患者小气道功能受累更严重,肺功能呼出50%肺活量时最大呼气流量占预计值%(MEF50占预计值%)在IPAH组和CTEPH组分别为(74±22)%和(59±27)%。IOS检查CTEPH组振荡频率为5和20Hz时气道阻力差值(R5-R20)为10.6(2.0,33.0),R5-R20与振荡频率为20Hz时的气道阻力比值(ΔR5-R20)为22.1(14.0,32.6),电抗面积为7.6(4.0,18.6),均高于IPAH组[2.5(-5.0,16.5)、15.5(7.0,23.2)、6.0(3.0,11.0),均P<0.05]。IPAH组中合并其他气道病变的患者与不合并气道病变的患者相比,小气道功能无明显统计学差异(P>0.05);合并气道疾病的CTEPH患者小气道功能比合并气道疾病的IPAH患者更差;不合并气道疾病的CTEPH患者小气道功能比不合并气道疾病的IPAH患者及对照组差。结论与IPAH患者相比,CTEPH患者平均确诊年龄高,确诊时血流动力学参数较好,合并气道疾病比例高,小气道功能受损更明显;不合并气道疾病的CTEPH患者的小气道功能差于不合并气道疾病的IPAH患者及健康人群。 Objective To investigate the peripheral small airway dysfunction differences between idiopathic pulmonary arterial hypertension (IPAH)and chronic thromboembolie pulmonary hypertension (CTEPH).Methods Impulse oseillmetory system testing (IOS)and pulmonary function testing (PFT)were performed in IPAH and CTEPH patients and 30 healthy control group.We also carried out a subgroup analysis depending on their medical history of airway diseases.Results We included 42 IPAH and 47 CTEPH patients (with or without airways disease:8 vs.34 and 17 vs.34,respectively).Compared withCTEPH patients,IPAH patients were younger but had more serious pulmonary vessel resistance and mean pulmonary arterial resistance.Compared with IPAH patients,CTEPH patients had significant impaired peripheral small airway dysfunction with decreased of MEF50(% pred),MMEF75/25 evaluated by PFT and R5-R20,△ R5-R20and AX measured by IOS [10.6(2.0,33.0)vs.2.5(-5.0,16.5);22.1(14.0,32.6)vs. 15.5(7.0,23.2);7.64(4,18.6)vs.6(3,11)respectively,all P<0.05].Subgroup analysis revealed there were no significant peripheral small dysfunction differences in IPAH patients with or without airway diseases. CTEPH patients had a higher proportion of airway diseases and more serious peripheral dysfunction than IPAH patients with airway diseases.Compared with control healthy group,peripheral airway dysfunction was more obvious even in IPAH and CTEPH patients without airway diseases.Conclusion Compared with IPAH,CTEPH patients were older,hut had better hemodynamies and a higher proportion of airway diseases. The peripheral airway dysfunction were more serious in CTEPH patients without airway diseases than IPAH patients without airway diseases and healthy controls group.
作者 安勤燕 姜蓉 王岚 赵勤华 宫素岗 何晶 罗祠君 刘敏琦 邱宏玲 郭健 刘锦铭 An Qinyan;Jiang Rong;Wang Lan;Zhao Qinhua;Gong Sugang;He Jing;Luo Sijun;Liu Minqi;Qiu Hongling;Guo Jian;Liu Jinming(Shanghai Pulmonary Hospital,Department of Lung Function Laboratory,Shanghai 210032,China;Department of Cardio-Pulmonary Circulation,Shanghai Pulmonary Hospital,Tongii University School of Medicine,Shanghai 210032,China)
出处 《中华结核和呼吸杂志》 CSCD 北大核心 2018年第12期934-941,共8页 Chinese Journal of Tuberculosis and Respiratory Diseases
基金 国家卫生计生委医药卫生科技发展研究中心课题项目(ZX-01-C2016144) 上海市科学技术委员会自然基金项目(16ZRl429000) 国家自然科学基金青年基金(81700045) 上海市卫生和计划生育委员会科研课题(20174Y0143).
关键词 高血压 肺性 呼吸功能试验 血流动力学 Hypertension pulmonary Respiratory function test Hemodynamics
作者简介 通信作者:刘锦铭,Email:jinmingliu@tongji.edu.com
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