慢性阻塞性肺疾病与肺动脉高压自然病程的探讨  

Investigation on natural history of chronic obstructive pulmonary disease and pulmonary arterial hypertension

作　　者：邹霞英[1] 辛达临[1] 李志斌[1] 张德明[1] 曹淑芳[1] 易仁亮[1] 

机构地区：[1]广州军区广州总医院老年三科(老年呼吸科),510010

出　　处：《国际呼吸杂志》2008年第15期904-906,共3页International Journal of Respiration

摘　　要：目的探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）并发肺动脉高压（pulmonary arterial hypertension，PAH）的发生和发展。方法对88例[COPD肺动脉平均压（mean pulmonary arterial pressure，MPAP）≤20mmHg（1mmHg=0．133kPa）]进行肺功能、心电图、血气及右心漂浮导管检测血流动力学，每5年一次共随访20年。结果①88例COPD随访至终点（20年或死亡），36例并发PAH（A组）死亡24例（66．7％）；其余52例未并发PAH（B组）死亡18例（34．6％）。MPAP平均每年上升0．51mmHg。②COPD急性加重次数〉3次／年A组为22例（66．1％），B组为12例（23．1％），两组差异有统计学意义（P〈0．05）。③COPD急性加重时MPAP、肺血管阻力、内皮素1、血栓素B2均高于稳定期（P〈0．05）。动脉血氧分压、氧输送量、一氧化氮、6-前列素Fia、均低于稳定期（P〈0．05）。结论PAH是COPD自然病程中一种常见的并发症，它的出现可以增加病死率；COPD急性加重频繁发作是诱发COPD并发PAH的重要因素之一。Objective To explore the natural history of pulmonary arterial hypertension（PAH） in chronic obstructive pulmonary disease （COPD）. Methods Eighty-eight patients with COPD [mean pulmonary arterial pressure（MPAP）≤20 mm Hg（1 mm Hg= 0. 133 kPa）]were followed up by 20 years. Pulmonary function,ECG, blood gas analysis and pulmonary hemodynamic were performed one time every five years. Results ① Thirty-six patients （40.9%） developed PAH （A group）, the mortality rate was 66.7%, in the other group（B group）, the mortality rate was 34.6%. The MPAP increased at an average rate of 0.51 mm Hg per year. ②A group with frequent exacerbations（〉3 times per year） had 22 patients （61.1%） ,B group had 12 patients （23.1%） （ P〉0.05）. ③The plasma level of endothelin-1 thromboxane B2 and MPAP, pulmonary vascular resistance in patients with exacerbation of COPD were singniticantly higher than those of stable patients（ P 〈0.05）. The plasma level of NO, 6-prostacyclin Fia and oxygen delirery,PaO2 were singniticantly lower than those of stable patients （ P〈0.05）. Conclusions PAH is a frequent complication in the natural history of COPD. Its presence is associated with higher mortality. Frequent exacerbation in COPD is one of the important factors inducing PAH.

关 键 词：慢性阻塞性肺疾病 肺动脉高压 血流动力学 急性加重 

分 类 号：R563.9[医药卫生—呼吸系统]