| ObjectivePulmonary hypertension(PH)is a common complication of chronic lung disease(CLD),which can be developed into chronic pulmonary heart disease and right heart failure,resulting in a worse prognosis and increased mortality.Objective to study the clinical characteristics and hemodynamic changes of chronic obstructive pulmonary disease(COPD)and bronchiectasis combined with pulmonary hypertension.Methods35 patients with pulmonary hypertension secondary to chronic pulmonary disease diagnosed by right cardiac catheterization collected from September 2015 to October 2017,which divided into chronic obstructive pulmonary disease combined with pulmonary hypertension(COPD-PH)group(n=18)and bronchiectasis combined with pulmonary hypertension(Branch-PH)group(n=17).Analysis of demography?clinical symptoms?6MWT?pulmonary function,WHO cardiac function classification?arterial blood gas analysis?echocardiography?hemodynamics and other biochemical tests.Results1)The mean age of the subjects was 57.77±12.86 years,the average age of patients in group COPD-PH was older than that of group Branch-PH(63.78±11.25 VS 51.41±11.56 years,P=0.003).The proportion of patients with smoking history in COPD-PH group was significantly higher than that in the branch-PH group(12 VS 2,P=0.000).The WHO heart function classification is mainly grade III in the COPD-PH group and the Branch-PH group.There was no significant difference in activity tolerance between the two groups.The 6-minute walking distance(6MWT)was 356.33±46.56 m in the COPD-PH group,and there was no significant difference from the 376.05±80.33 m in the Branch-PH group(P=0.162).Patients in the Bronch-PH group come out a longer average duration of disease than that in the COPD-PH group(20.59±11.10 VS 10.22±6.52 years,P=0.000).Cough,phlegm,dyspnea,and post-activity shortness of breath were the most common symptoms in two groups of patients with pulmonary hypertension.Whearas,the proportion of patients with hemoptysis in the Branch-PH group was significantly higher than that in the COPD-PH group.2)The arterial blood gas analysis indicated that the PaO2 in the COPD-PH group and the branch-PH group decreased significantly,(77.86±23.94 mmHg VS 66.03±19.32 mmHg,P>0.05),However,there was no significant difference between the two groups.And,type II respiratory failure was the main type of respiratory failure in both groups.Patients of group COPD-PH pulmonary dysfunction mainly obstructive lung function(n = 5,27.8%)and mixed ventilation dysfunction(n=13,72.2%),while in group Branch-PH,mainly restrictive lung dysfunction(n = 6,35.3%)and mixed ventilation dysfunction(n=11,64.7%)(P=0.002).And there was a significant decrease in the FEV1% of the two groups(34.92±17.57% VS 38.14±12.77%,P>0.05).The FEV1/FVC% of the-PH group was 66.79 + 12.14%,which was significantly higher than that of the COPD-PH group(48.71 < 16.28%)(P =0.001).Echocardiography indicated that the right atrium and right ventricle of both groups had hyperplasia of different degrees,the diameter of right atrium and right ventricle in Branch-PH group was larger than that of group COPD-PH(RA:44.00±8.22 VS 42.50±7.44,RV:29.18±8.55 VS 26.39±6.19)mm,but no statistically significant difference(P>0.05).The left ventricular end diastolic dimension(LVDd)of the COPD-PH group was significantly greater than that of the Branch-PH group(43.22±5.30mmVS38.65 + 6.04 mm,P < 0.05).10 patients(55.56%)had left ventricular diastolic dysfunction were found in COPD-PH group,while 8 patients(47.1%)in Branch-PH group.3)Patients with COPD-PH group were mainly characterized by mild to moderate pulmonary hypertension(n=15,83.30%),while the patients with branching-ph group were mainly moderate to severe pulmonary hypertension(n=12,71.48%).The mean pulmonary arterial pressure(mPAP)in the Branch-PH group was 43.29 + 12.77 mmHg,which was significantly higher than that in the COPD-PH group 35.67 + 7.40 mmHg,(P =0.042).Compared with the pulmonary vascular resistance(PVR)in COPD-PH group,the pulmonary vascular resistance(PVR)in Branch-PH group was 8.48(5.75-11.48)wood.,which was significantly higher than that of the COPD group 4.24(3.15-6.35)wood(P=0.002).Meanwhile,the total pulmonary resistance(TPR)in Branch-PH group was 11.19 + 4.43 wood significantly higher than that of the COPD-PH group 7.77±3.71 wood(P=0.018).There were no statistically significant differences in the other hemodynamic parameters of the two groups: right atrial pressure(RAP)?pulmonary artery systolic pressure(PASP)?pulmonary artery diastolic pressure(PADP)?right ventricular average pressure(RVP)? cardiac output(CO)? cardiac index(CI)and oxygen saturation of mixed venose blood(Svo2).3)There was a significant positive correlation among PLT?RA?RV?RVS P?RAP and RHC-mPAP(PLT,r=0.413,P=0.014;RA,r=0.332,P=0.038;RV,r=0.474,P=0.001;RVSP,r=0.729,P<0.001;R VMP,r=0.884,P<0.001),while PaO2,LVDd was negatively correlated with RHC-mPAP(PaO2,r=-0.384,P=0.023;LVDd,r=-0.334,P=0.042).Similarly,PLT?RV?RVSP?RVMP were positively correlated with RHC-PVR(PLT,r=0.402,P=0.017;RA,r=0.391,P=0.020;RVSP,r=0.373,P=0.027;RVMP,r=0.500,P=0.002).but,LA?LVDd?CO?CI were negatively correlated with RHC-PVR(LA,r=-0.431,P=0.010;LVDd,r=-0.562,P<0.001;CO,r=-0.580,P<0.001;CI,r=-0.582,P<0.001;).Moreover,There was a significant positive cor relation among PLT?CL?RA?RVSP?RVMP and RHC-TPR(PLT,r=0.357,P=0.035;CI,r=0.699,P<0.001;RA,r=0.474,P=0.040;RVSP,r=0.355,P=0.049;RVMP;r=0.507,P=0.002).while,a negative significant correlation was observed between RHC-TPR and PaO2,LVDd,CO(PaO2,r=-0.368,P=0.030;LVDd,r=-0.546,P=0.001,CO,r=-0.692,P<0.001).In addition,there was a high statistically significant positive correlation between SPAP values and Paco2(r=0.321,P=0.036),however,LA?LVDd were negatively correlated with RHC-PVR(LA,r=-0.461,P=0.005;L VDd,r=-0.507,P=0.002).ConclusionPulmonary hypertension secondary to COPD and bronchiectasis are chronic progression of disease.,ranging from symptoms to the duration of the diagnosis in more than 10 years.The progression of pulmonary hypertension in patients with bronchiectasis is longer than that of COPD,and the patients with bronchiectasis are younger than those with COPD.A long-term bronchial dilatation is also an important risk factor for pulmonary hypertension,and the mean pulmonary arterial pressure and pulmonary vascular resistance in patients with bronchiectasis combined with pulmonary hypertension are higher than those of COPD patients. |
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