肺动脉高压患者肺功能变化特点研究

Characteristics of pulmonary function in patients with pulmonary hypertension

目的探讨肺动脉高压患者进行常规肺功能（PFT）及脉冲震荡肺功能（IOS）测定的临床意义。方法对51例经右心导管检查确诊的特发性肺动脉高压（IPAH）患者及慢性血栓栓塞性肺动脉高压（cTEPH）患者和20名健康者依次进行脉冲震荡肺功能及常规肺功能检测，分析两组人群肺功能各项指标的变化特点。结果IPAH患者一氧化碳弥散量占预计值百分比（D。CO％pred）较CTEPH患者明显下降（76．60±19．98和93．62±18．77，P〈0．01），肺动脉高压组较正常对照组FEVlOpred、FVC％pred、FEV1／FVC、最大呼气中期流量占预计值百分比（MMEF％pred）、最大自主通气量占预计值百分比（MVV％pred）、DLCO％pred等指标明显降低（分别为82．17±16．19和98．38±7．95，88．13±16．64和97．93±9.7，78．66±7．47和84。47±4．58，57．34±16．14和81.18±17．82，83．08±30．41和108．21±27．04，83．61±21．07和109．86土15．73，P〈O．01），气道总阻力占预计值百分比（Rtot％pred）、Z5占预计值百分比（Z50pred）、R5占预计值百分比（R5Yopred）、R5-R20、X5、AX、Fres等指标明显升高（分别为131．16±46．22和90．90士28．99，146．98±59．22和104．21±19．93，139．57±53．68和100．10±8．79，1．68±1．52和0．45±0．25，1．37±1．19和0．89±0．20，12．78±15．63和5．73±2．49，17．22±5．94和10．33±1．87，P〈O．01）。WHO肺动脉高压功能分级（WH0FC）UI级患者较Ⅱ级患者R5-R20、X5、AX、Fres等指标明显升高（分别为2．28±1．88和1.11±0．73，1．77±1．55和0．98±0．45，18．27±20．47和7．50±5．20，18．92±6．50和15．58±4．93，P〈0．05）。结论IPAH患者较cTEPH患者平均确诊年龄更低。但确诊时血流动力学指标受损更严重，肺功能指标除弥散功能IPAH患者更差外，其他肺功能改变两类患者基本类似。肺动脉高压患者存在轻度限制性及阻塞性通气障碍和弥散功能障碍，气道阻塞主要考虑外周小气道引起，而且WHO肺动脉高压功能分级越高，其外周小气道阻塞情况越严重，对于肺动脉高压发生高危人群持续定期的DLCO监测，可能有助于早期检出肺动脉高压。

Objective To study the pulmonary function characteristics of patients with pulmonary hypertension （PH）. Methods Impulse Oscillmetory system testing （IOS） and pulmonary function testing （PFT） were performed in 51 PH patients （including 30 IPAH patients and 21 CTEPH patients） diagnosed by right heartcatheterization and in 20 healthy control. Results DLCO%pred in IPAH patients was significant lower than that in CTEPH patients （76.60 ± 19.98 vs 93.62 ± 18.77, P 〈0.01）. FEVI pred, FVC pred, FEV1/FVC, MMEF% pred, MVV pred, DLCO % pred in PH group were significant lower than those in control group （82.17±16.19 vs 98.38±7.95,88.13±16.64 vs 97.93±9.17,78.66± 7.47 vs 84.47±4.58,57.34±16.14 vs 81.18±17.82,83.08±30.41 vs 108.21±27.04,83.61_±21.07 vs 109.86± 15.73, P 〈0.01）,Rtotpred,ZSpred, RS^pred, R5 R20 （cmH20 · L-1· s-1）,XS, （cmH2O· L-1· s-1）,AX（cmH2O/L）,Fres（L/s）in PH group were significant higher than those in control group （131.16 4- 46.22 vs 90.90±28.99,146.98±-59.22 vs 104. 21± 19.93,139.57± 53.68 vs 100. 10±18.79,1.68±1.52 vs 0.45±0.25,1.37±1.19 vs 0. 89±0. 20,12. 78± 15.63 vs 5.73±2.49, 17.22±5.94 vs 10.33±1.87, P〈0.01）. RS-R20（cmH2O· L-1· s-1）,XS,（cmH2O· L-1· s-1）,AX （cmH2 O/L）,Fres（L/s） in PH patients with WHO cardiac function level Ill were significant higher than those inPH patients with cardiac Function levelⅡ （2.28±1.88 vs 1.11±0.73,1.774±1.55 vs 0.98± 0.45,18.27±20.47 vs7.504±5.20,18.92±6.50 vs 15.58±4.93, P〈0.05）Conclusions The average age oF diagnosis in IPAH patients is lower than in CTEPH patients,but the indexes of hemodynamics are more severely impaired. Pulmonary Function changes with similar in IPAH patients and in CTEPH patients except for diffuse function. Pulmonary hypertension in patients with mild restrictive and obstructive ventilatory disorder and diffusion dysfunction, airway obstruction mainly consider the peripheral small airway caused,and WHO-FC grade is higher, the peripheral small airway obstruction is more serious. To the high-risk population oF pulmonary hypertension, regular DLCO monitoring may be helpful in the early detection of pulmonary hypertension.