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呼气末二氧化碳分压评估特发性肺动脉高压与慢性血栓栓塞性肺动脉高压严重程度的价值
史雪
杨国玲
陈杨
郭健
杨文兰
袁平
宫素岗
姜蓉
赵勤华
王岚
何晶
陈天翔
刘锦铭
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-0939.2017.01.008
End tidal PCO 2 for evaluation of severity of disease in idiopathic pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension
Shi Xue
Yang Guoling
Chen Yang
Guo Jian
Yang Wenlan
Yuan Ping
Gong Sugang
Jiang Rong
Zhao Qinhua
Wang Lan
He Jing
Chen Tianxiang
Liu Jinming
Authors Info & Affiliations
Shi Xue
Tongji University School of Medicine, Shanghai 200092, China
Yang Guoling
Chen Yang
Guo Jian
Yang Wenlan
Yuan Ping
Gong Sugang
Jiang Rong
Zhao Qinhua
Wang Lan
He Jing
Chen Tianxiang
Liu Jinming
·
DOI： 10.3760/cma.j.issn.1001-0939.2017.01.008
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摘要

目的观察特发性肺动脉高压(IPAH)和慢性血栓栓塞性肺动脉高压(CTEPH)患者的呼气末二氧化碳分压(P ETCO 2)，分析P ETCO 2评估疾病严重程度的价值。

方法回顾性分析2011年10月至2014年10月上海市肺科医院住院治疗的患者120例，其中男45例，女75例，68例为IPAH，52例为CTEPH。所有患者均行右心导管检查、肺功能测试及心肺运动试验，采用病例对照研究方法比较2组患者疾病严重程度，根据世界卫生组织心功能分级(WHO－FC)将2组患者细分为Ⅰ－Ⅱ级亚组和Ⅲ－Ⅳ级亚组，观察P ETCO 2差异。

结果IPAH组平均肺动脉压(mPAP)和肺血管阻力(PVR)[(60±16) mmHg(1 mmHg＝0.133 kPa)、(13±6) Wood U ]均高于CTEPH组[(46±12) mmHg、(9±4) Wood U， t值分别为4.90和4.83，均 P<0.01]，峰值摄氧量占预计值%和峰值脉搏氧占预计值% [(45±15)%、(60±22)% ]均低于CTEPH组[(53±16)%、(68±21)%， t值分别为－2.42和－1.96，均 P<0.05]。IPAH组P ETCO 2静息期[(27±5) mmHg]、无氧阈期[(28±7) mmHg]及峰值[(25±7) mmHg]均高于CTEPH组[(24±4)、(23±6)、(21±6) mmHg， t值为3.22～4.54，均 P<0.01]。IPAH组WHO－FC Ⅰ－Ⅱ级和Ⅲ－Ⅳ级亚组间比较无氧阈期和峰值P ETCO 2差异有统计学意义( t值分别为2.55和2.60，均 P<0.05)；CTEPH组仅P ETCO 2无氧阈期亚组间有显著差异( t＝2.39， P<0.05)，峰值亚组间差异不明显( t＝1.71， P>0.05)。IPAH组P ETCO 2无氧阈期与NT－proBNP呈中度负相关( r＝－0.58， P<0.01)，而CTEPH组仅呈弱负相关性( r＝－0.34， P＝0.02)。

结论与CTEPH患者相比，IPAH患者的运动耐力低，P ETCO 2高，P ETCO 2在2组患者中均可反映疾病严重程度，但对IPAH患者评估价值更高，P ETCO 2无氧阈期反映通气效率优于峰值。

高血压，肺性;慢性血栓栓塞性肺动脉高压;运动心肺功能;呼气末二氧化碳分压
ABSTRACT

ObjectiveTo explore the difference in end tidal PCO 2 (P ETCO 2) between idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH), and to analyze the correlation between P ETCO 2 and the indexes of disease severity in IPAH and CTEPH patients.

MethodsData were retrieved from 68 IPAH patients and 52 CTEPH patients who all had received right-heart catheterization, pulmonary function test and cardiopulmonary exercise testing at Shanghai Pulmonary Hospital from October 2011 to October 2014. In addition, other clinical parameters were also collected.

ResultsThe IPAH group had a significantly higher mPAP, PVR [(60±16) mmHg (1 mmHg=0.133 kPa), (13±6) Wood U ] than the CTEPH group [(46±12) mmHg, (9±4) Wood U, t=4.90, 4.83, all P<0.01]. Meanwhile, the IPAH group had a lower percentage of predicted peakVO 2, oxygen pulse [(45±15)%, (60±22)%] compared with the CTEPH group [(53±16)%, (68±21)%, t=-2.42, -1.96, all P<0.05]. The value of P ETCO 2 at rest, AT, peak in the IPAH patients [(27±5), (28±7), (25±7) mmHg] were higher than those in the CTEPH patients [(24±4) mmHg, (23±6) mmHg, (21±6) mmHg, t=3.22-4.54, all P<0.01]. There was a significantly difference in P ETCO 2 at AT and peak between WHO-FC Ⅰ-Ⅱ and Ⅲ-Ⅳ subgroups in IPAH ( t=2.55, 2.60, all P<0.05) and CTEPH ( t=2.39, P<0.05), except for P ETCO 2 at peak in the CTEPH patients ( t=1.71, P>0.05). A moderately inverse correlation was found between P ETCO 2 at AT and NT-proBNP in the IPAH group ( r=-0.58, P<0.01), meanwhile P ETCO 2 at AT in the CTEPH group was weakly correlated with NT-proBNP ( r=-0.34, P<0.05).

ConclusionsCompared with the CTEPH patients, the IPAH patients had significantly decreased exercise capacity and increased P ETCO 2. P ETCO 2 could reflect the disease severity in both IPAH and CTEPH patients, being superior in IPAH than in CTEPH. Furthermore, P ETCO 2 at AT might be better than P ETCO 2 at peak in reflecting the ventilatory efficiency.

Hypertension, pulmonary;Chronic thromboembolic pulmonary hypertension;Cardiopulmonary exercise testing;End tidal PCO 2
Liu Jinming, Email: mocdef.6ab213102uilgnimnij
National Health and Family Planning Commission of the People’s Republic of China, Medical and Health Science Technology Development Research Center’s project(W2015RNA09B)
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引用本文

史雪,杨国玲,陈杨,等. 呼气末二氧化碳分压评估特发性肺动脉高压与慢性血栓栓塞性肺动脉高压严重程度的价值[J]. 中华结核和呼吸杂志,2017,40(1)：34-39.

DOI:10.3760/cma.j.issn.1001-0939.2017.01.008

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特发性肺动脉高压(idiopathic pulmonary arterial hypertension，IPAH)及慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension，CTEPH)是肺动脉高压的两种类型 [ 1 , 2 , 3 ]，发病率相对较高 [ 4 , 5 ]，均存在典型肺血管病变及异常的气体交换模式 [ 5 , 6 , 7 ]。心肺运动试验(cardiopulmonary exercise testing，CPET)在监测气体交换异常方面具有重要价值 [ 8 ]，其关键参数可用于肺动脉高压患者运动限制的严重程度分级 [ 8 , 9 , 10 ]，监测运动介导的右向左分流 [ 11 , 12 ]，评估药物疗效以及疾病预后 [ 1 , 13 , 14 ]。呼气末二氧化碳分压(end tidal partial pressure of CO 2，P ETCO 2)是CPET评价通气效率的重要参数之一，其不需特殊计算，可直接从气道中测得 [ 10 ]。近年来，P ETCO 2在心肺疾病中受到广泛关注，国外研究结果显示，P ETCO 2可用于慢性心力衰竭患者的疾病严重程度分级 [ 15 , 16 , 17 ]，并在识别系统性硬化症患者的早期肺血管病变方面具有重要价值 [ 18 ]。但目前有关IPAH及CTEPH的P ETCO 2的特点及应用的研究较少，本研究探讨了IPAH与CTEPH的P ETCO 2特点，并将P ETCO 2与疾病严重程度参数进行相关性分析，探讨P ETCO 2评价IPAH及CTEPH疾病严重程度的价值。
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备注信息
A
刘锦铭，Email： mocdef.6ab213102uilgnimnij
B
国家卫生计生委医药卫生科技发展研究中心课题项目 (W2015RNA09B)
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