慢性血栓栓塞性肺动脉高压患者小气道功能与血流动力学相关性研究

Correlation between small airway function and hemodynamics in patients with chronic thromboembolic pulmonary hypertension

关键词:  慢性血栓栓塞肺动脉高压  肺功能  脉冲振荡肺功能  血流动力学

Key words:  chronic thromboembolic pulmonary hypertension  pulmonary function test  impulse oscillometry lung function  hemodynamics

摘要:

目的 研究慢性血栓栓塞性肺动脉高压（chronic thromboembolic pulmonary hypertension, CTEPH）患者的小气道功能特点及与血流动力学的相关性。方法 选取2015年11月—2017年11月在同济大学附属上海市肺科医院肺循环科确诊为CTEPH患者共47例（17例患者合并气道疾病，30例不合并气道疾病），选取30位健康人为对照组，进行常规肺功能(pulmonary function test, PFT)及脉冲振荡肺功能（impulse oscillometry lung function, IOS）检查，分析CTEPH患者小气道功能变化特点及其与血流动力学相关性。结果 PFT检测显示，CTEPH患者呼出25%肺活量时的最大呼气流量占预计值百分比(MEF25% pred）、呼出50%肺活量时的最大呼气流量占预计值百分比(MEF50% pred）、最大呼气中期流速占预计值百分比（MMEF75/25% pred）均较正常对照组明显减退。IOS检查发现，CTEPH患者振荡频率为5Hz和20Hz时气道阻力差值（R5～R20）[10.6(2.0, 33.0) vs 1.0(0,1.0)]、振荡频率为5Hz和20Hz时气道阻力差值/振荡频率为20Hz时的气道阻力(ΔR5～R20)[22.1(14, 32.6) vs 2.0(1.0,2.0)]、电抗面积（AX）[7.6(4.0,18.6) vs 3.5（2.0,2.5）]均较对照组明显升高，差异有统计学意义（P＜0.05）。单纯不合并气道疾病的CTEPH患者的小气道功能同样差于正常对照组人群。相关性分析中全部47例CTEPH患者及合并气道疾病的17例CTEPH患者的小气道功能与血流动力学无明显相关性，而去除气道疾病的影响后，30例单纯不合并气道疾病的CTEPH患者的小气道功能指标R5～R20、ΔR5～R20与PVR呈正相关，而MEF25、MEF50、MMEF75/25与PVR及mPAP均呈负相关，且相关性具有统计学意义（P均＜0.05）。结论 合并气道疾病的CTEPH患者小气道功能较不合并气道疾病的CTEPH患者小气道功能受损更明显，不合并气道疾病的CTEPH患者的小气道功能同样差于正常对照组人群，且与血流动力学指标PVR、mPAP具有明显的相关性。

Abstract:

Objective To investigate the correlation between small airway function and hemodynamics in patients with chronic thromboembolic pulmonary hypertension(CTEPH). Methods Impulse oscillmetory system testing (IOS) and pulmonary function testing (PFT) were performed in 47 CTEPH patients (30 cases with airway disease and 17 cases without airway disease) and 30 healthy subjects (control group). The correlation of small airway function and hemodynamics of patients were analyzed. Results Compared with control group, CTEPH patients had significant impaired peripheral small airway function with decreased of MEF25(%pred), MEF50(% pred), MMEF75/25 as evaluated by PFT and R5-R20, ΔR5-R20 and AX as measured by IOS [10.6(2.0,33.0) vs 1.0(0,1.0); 22.1(14,32.6) vs 2.0(1.0,2.0); 7.6(4.0,18.6) vs 3.5（2.0,2.5）respectively, all P＜0.05]. CTEPH patients had a higher proportion of airway diseases and more serious peripheral dysfunction than the control group. In 30 cases of CTEPH patients without airway diseases, the small airway function indicator R5-R20 and ΔR5-R20 were positively corrected with pulmonary vascular resistance (PVR) and MEF25, MEF50, MMEF75/25 were negatively correlated with PVR and mean pulmonary arterial pressure (mPAP). But the correlation between small airway function and hemodynamics was not observed in overall 47 CTEPH cases and 17 CTEPH cases with airway diseases. Conclusion CTEPH patients with airway diseases have more severe airway dysfunction than those without airway diseases, and the latter have more severe airway dysfunction than healthy subjects. The hemodynamic index PVR was correlated with mPAP in CTEPH patients without airway diseases.