肺动脉高压对等待肺移植的慢性阻塞性肺疾病患者预后的影响  

Influence of pulmonary hypertension on patients with advanced chronic obstrnctive pulmonary disease prior to lung transplantation

作　　者：毛文君[1] 陈静瑜[1] 郑明峰[1] 陈若[1] 何毅军[1] 刘峰[1] 叶书高[1] 陆荣国[1] Mao Wenjun;Chen Jingyu;Zheng Mingfeng;Chen Ruo;He Yijun;Liu Feng;Ye Shugao;Lu Rongguo(Department of Thoracic Surgery, Lung Transplantation Center, Key Laboratory of Human Organ Transplantation in Jiangsu Province, Affiliated Wuxi People’s Hospital, Nanjing Medical University, Wuxi 214023, China)

机构地区：[1]南京医科大学附属无锡市人民医院胸外科、肺移植中心、江苏省人体器官移植重点实验室,江苏无锡214023

出　　处：《中华器官移植杂志》2018年第9期553-558,共6页Chinese Journal of Organ Transplantation

基　　金：江苏省科教强卫工程青年医学重点人才项目(QNRC2016193);南京医科大学科技发展基金面上项目(2015NJMU146).

摘　　要：目的探讨肺动脉高压(pulmonaryhypertension,PAH)对肺移植等待列表中慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)患者预后的影响。方法自2014年1月至2016年8月对143例COPD患者进行了肺移植评估,COPD患者术前常规接受右心导管监测平均肺动脉压力(mPAP),mPAP≥25mmHg时,即确诊为PAH,mPAP≥35mmHg确诊为严重PAH。统计PAH的发病率,根据不同PAH定义标准,对患者进行分组,使用Kaplan-Meier法绘制生存曲线,Log-rank法分析对移植等待列表中PAH对COPD患者存活的影响,单因素和多因素COX比例风险回归模型分析评估各因素对生存的影响。肺移植等待列表中COPD患者的存活时间,即进入肺移植等待列表的时间至在移植列表中死亡或出现删除事件的时间,后者指患者接受了肺移植,由于各种原因移植前被移出等待列表,或至随访截至日期(2016年8月30日)患者仍在肺移植等待列表中。结果所有评估的143例患者中,男性119例,女性24例,平均年龄61.73岁,46例接受了肺移植治疗,97例未行肺移植,平均肺动脉压≥25mmHg50例,平均肺动脉压≥35mmHg21例。其中23例(22.88%)患者在移植等待列表中死亡,38例被移出移植等待列表,36例继续等待肺移植。以25mmHg或35mmHg为界,等待列表中肺动脉高压组的患者生存时间均显著低于非肺动脉高压组患者(P<0.001),单因素COX比例风险回归模型分析显示PAH(≥25mmHg)和严重PAH(≥35mmHg)均是肺移植等待列表中患者死亡的危险因素(HR=2.147,95%CI1.429-3.157,P<0.001;HR=3.458,95%CI2.518-4.859,P<0.001),多因素COX比例风险回归模型分析显示PAH(HR=2.518,95%CI1.728-3.364,P<0.001)和严重PAH(HR=4.027,95%CI3.257-4.703,P<0.001)均为等待列表中COPD患者死亡的危险因素。结论在肺移植等待列表中,COPD患者PAH发病率较高,合并肺动脉高压会增加COPD患者死亡的风险。ObjectiveTo study the influence of pulmonary artery hypertension (PAH) on survival of patients with advanced chronic obstructive pulmonary disease (COPD) on the waiting list of lung transplantation. MethodsThe characteristics of 143 patients with COPD receiving lung transplantation evaluation from January 2014 to August 2016 were queried. Mild PAH was defined as mean pulmonary artery pressure (mPAP)≥25 mmHg and severe ≥35 mmHg by right heart catheterization measurements. The incidence of PAH was studied, and the patients were divided to different groups to determine the effect of PAH on survival prior to transplantation on the basis of different definitions of PAH. Kaplan Meier method was used to draw survival curves, and a log-rank test was used to analyze the effect of PAH on survival of COPD patients on the waiting list of pulmonary transplantation. Univariate and multivariate Cox proportional hazard models were performed to test the relationship between each main covariate and the hazard of mortality. The waiting time was tracked from wait list entry date until death or censoring, and the censoring issues were as follows: receiving lung transplantation, removing from the waiting list without transplant, and still wating for donor until the last follow-up day (2016-08-30). ResultsOf 143 COPD patients, there were 119 males and 24 males, with mean age of 61.73 years old;46 patients received lung transplantation, and the remaining 97 not;50 had mPAP ≥25 mmHg and 21 had mPAP ≥35 mmHg. A total of 23 cases (22.88%) died on the waiting list. Thirty-eight patients were removed from the list prior to transplantation, and 36 were still on the waiting list. Kaplan-Meier survival function showed suvival of patients with mild PAH or severe PAH was significantly shorter than that of patients without PAH (P<0.001). Using Cox proportional hazards models, univariate analysis revealed significant differences in survival for mild PAH (HR=2.147, 95%CI 1.429-3.157, P<0.001) and severe PAH (HR=3.458, 95%CI 2.518-4.859, P<0.

关 键 词：肺移植 肺动脉高压 慢性阻塞性肺疾病 预后 

分 类 号：R544.1[医药卫生—心血管疾病] R655.3[医药卫生—内科学]