EmPHasis-10 球囊血管成形术后慢性血栓栓塞性肺动脉高压的健康相关生活质量和运动能力

2022-09-05 刘少飞 MedSci原创

本研究旨在使用 emPHasis-10 问卷评估疾病特异性生活质量,并评估其在肺血流动力学正常的慢性血栓栓塞性肺动脉高压患者中的决定因素。

慢性血栓栓塞性肺动脉高压(CTEPH)是肺动脉高压(PH)的一个重要分类,并且与显着的发病率和死亡率相关。其主要临床表现包括劳力性呼吸困难,并伴有运动能力和生活质量(QOL)的显着降低。虽然肺动脉内膜切除术 (PEA) 传统上作为 CTEPH 患者的主要治疗方法,但随着球囊肺血管成形术 (BPA) 的发展,治疗选择已经扩大,从而改善了预后。然而,即使在 BPA 介导的静息血流动力学正常化之后,也有报道称运动能力和生活质量下降;因此,症状的改善被认为是 CTEPH 患者管理的下一个治疗目标。最近,CTEPH 患者的治疗决策不仅考虑疾病特异性结果(例如,改善预后和缓解 PH),还考虑以患者为中心的结果(例如,改善 QOL 和减轻症状负担)。在第六届世界 PH 研讨会上,健康相关生活质量的疾病特异性测量被强调为临床试验中相关和重要的终点。这些措施也应与治疗 CTEPH 的日常临床实践相结合,正如对心力衰竭等其他心血管疾病所做的那样。

emPHasis-10 问卷是对 PH 患者 QOL 的单维疾病特异性患者报告结果评估,可用于临床试验和常规护理。它包括 10 个关于 PH 重要组成部分的问题,例如呼吸困难、疲劳、精力不足、社会限制以及对疾病对患者家人和朋友的影响的担忧。EmPHasis-10 评分与 PH 患者(包括 CTEPH 患者)的运动能力和血流动力学相关。它在临床护理中的部分效用源于其与长期预后的密切关联。尽管最近提出通过将平均肺动脉压 (PAP) 阈值从 25 mm Hg 降低到 20 mm Hg 来重新定义 PH,但在平均 PAP 为<25 毫米汞柱。这代表了一个重要的知识差距,因为这些可修改的决定因素可能是旨在改善接受 BPA 治疗的 CTEPH 患者生活质量的干预措施的潜在目标。

我们最近报道,在 BPA 后血流动力学改善的 CTEPH 患者中,功能能力受损很常见。此外,我们发现 6 分钟步行距离 (6MWD) 是日常生活中广泛使用的功能能力参数,主要由外周因素定义,而不是静息时的肺血流动力学。此外,即使在血流动力学正常化后,一些患者仍难以摆脱家庭氧气 (O 2 ) 治疗 (HOT);这可能对生活质量产生不利影响。本研究的目的是使用 emPHasis-10 评估疾病特异性 QOL,并评估其在 BPA 后肺血流动力学正常化的 CTEPH 患者中的决定因素。

研究目的:

肺血流动力学参数和功能能力是否与慢性血栓栓塞性肺动脉高压患者的生活质量相关仍然未知。本研究旨在使用 emPHasis-10 问卷评估疾病特异性生活质量,并评估其在肺血流动力学正常的慢性血栓栓塞性肺动脉高压患者中的决定因素。

方法和结果:

这项横断面研究包括对 143 名慢性血栓栓塞性肺动脉高压患者(中位年龄,68 [58-75] 岁;男性/女性,51/136;使用家庭氧疗,51 名患者 [27%])的 187 项健康状况评估) 球囊肺血管成形术后,平均肺动脉压在静息时 <25 mm Hg。进行了右心导管插入术,然后评估了 6 分钟步行距离和 emPHasis-10 问卷。中位肺动脉压力和肺血管阻力分别为 18 (15-21) mm Hg 和 2.2 (1.7-2.9) 木单位。emPHasis-10 评分中位数为 14 (8-24),而 6 分钟步行距离中位数为 447 (385-517) 米。单变量线性回归分析表明,emPHasis-10 评分与 6 分钟步行距离相关(β=-0.476 [95% CI -0.604, -0.348],P <0.001) 和家庭氧疗 (β=0.214 [95% CI, 0.072, 0.356], P =0.003) 但与血流动力学参数无关。多元回归分析显示,较高的 emPHasis-10 评分与较低的 6 分钟步行距离相关(β=-0.475 [95% CI,-0.631 至 -0.319],P <0.001)。

图1.比较接受和不接受家庭氧疗的患者中每个 emPHasis-10 子项的箱线图。家庭氧疗用浅灰色条表示。深灰色条表示没有家庭氧疗。* P <0.05 和 ** P <0.01。

研究结论:

在慢性血栓栓塞性肺动脉高压和球囊肺血管成形术后血流动力学正常化的患者中,健康相关的生活质量与运动能力和家庭氧疗的使用有关,但与血流动力学参数无关。运动能力的提高可能会导致生活质量的进一步提高。

 

参考文献:

Sakamoto H, Goda A, Tobita K, Takeuchi K, Kikuchi H, Inami T, Tamura Y, Kohno T, Yamada S, Soejima K, Satoh T. EmPHasis-10 Health-Related Quality of Life and Exercise Capacity in Chronic Thromboembolic Pulmonary Hypertension After Balloon Angioplasty. J Am Heart Assoc. 2022 Sep 3:e026400. doi: 10.1161/JAHA.122.026400. Epub ahead of print. PMID: 36056723.

 

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