Pneumologie 2013; 67(09): 502-508
DOI: 10.1055/s-0033-1344553
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Bedeutung der Lungenfunktion für die pulmonale Hypertonie bei Sarkoidose

Importance of Lung Function for Pulmonary Hypertension in Sarcoidosis
M. Held
Missionsärztliche Klinik GmbH Würzburg, Abteilung Innere Medizin (Chefarzt Prof. Dr. med. Berthold Jany)
,
D. Jonas-Klemm
Missionsärztliche Klinik GmbH Würzburg, Abteilung Innere Medizin (Chefarzt Prof. Dr. med. Berthold Jany)
,
B. H. Jany
Missionsärztliche Klinik GmbH Würzburg, Abteilung Innere Medizin (Chefarzt Prof. Dr. med. Berthold Jany)
› Author Affiliations
Further Information

Publication History

eingereicht03 June 2013

akzeptiert nach Revision09 July 2013

Publication Date:
04 September 2013 (online)

Zusammenfassung

Hintergrund und Fragestellung: Angaben zur Häufigkeit der pulmonalen Hypertonie (PH) bei Sarkoidose schwanken und hängen vom ethnischen und pathophysiologischen Hintergrund und der diagnostischen Methode ab. Ziel dieser Arbeit war, Häufigkeit und Schweregrad der PH und deren Abhängigkeit von Ventilation und Gasaustausch bei der Sarkoidose zu untersuchen.

Methode: Wir analysierten retrospektiv Daten aus Bodyplethysmografie, Blutgasanalyse und Echokardiografie sowie des Rechtsherzkatheters von 123 Patienten mit Sarkoidose.

Ergebnisse: Eine PH zeigten 5,6 % der Patienten. Eine Lungenparenchymbeteiligung (59,4 % aller Patienten) hatte keinen Einfluss auf die PH. VC (p < 0,001), FEV1 (p < 0,001), FEV1/VC (p = 0,01), TLCO/VA (p < 0,001), pO2 (p = 0,04) und SO2 (p < 0,01), nicht aber ITGV, TLC und RV waren bei Patienten mit PH signifikant niedriger. VC (R = −0,52, p < 0,01), FEV1 (R = −0,53, p < 0,01), DLCO-VA (R = −0,55, p = 0,02) sowie pO2 (R = −0,69, p = 0,04) und SO2 (R = −0,91, p < 0,001) korrelierten signifikant negativ mit der Höhe des RVSP.

Schlussfolgerung: Häufigkeit und Schwere der PH bei Sarkoidose entsprachen den Daten japanischer Kollektive, die PH ist seltener und leichtgradiger als bei afroamerikanischen Patienten. RVSP korreliert mit der Einschränkung der Ventilation und der Oxygenierung, ist aber nicht von einer Lungenparenchymmanifestation abhängig. Es sollte prospektiv geprüft werden, inwieweit die Einschränkung von VC und FEV1 und ihre Korrelation mit RVSP eine Einschränkung der Atempumpenkraft widerspiegeln.

Abstract

Background: The reported prevalence of pulmonary hypertension (PH) in sarcoidosis is variable and depends on the ethnic background, the underlying pathophysiology and the diagnostic methods used. We aimed to analyse the prevalence and the severity of PH and its relationship to ventilation and gas exchange in sarcoidosis.

Methods: We performed a retrospective analysis of echocardiography, pulmonary function tests, blood gases and right heart catheterisation of 123 patients with sarcoidosis.

Results: 5.6 % of all patients showed pulmonary hypertension. Parenchymal lung abnormalities (seen in 59.4 % of all patients) had no influence on PH. In patients with PH VC (p < 0.001), FEV1 (p < 0.001), FEV1/VC (p = 0.01), TLCO/VA (p < 0.001), pO2 (p = 0.04) and SO2 (p < 0.01), but not ITGV, TLC and RV were significantly lower. We found significant negative correlations for right ventricular systolic pressure (RVSP) and VC (R = −0.52, p < 0.01), FEV1 (R = −0.53, p < 0.01), DLCO-VA (R = −0.55, p = 0.02), pO2 (R = −0.69, p = 0.04) and SO2 (R = −0.91, p < 0.001).

Conclusion: Prevalence and severity of PH were similar to published Japanese data, but were less than reported in African-Americans. PH was associated with decreased vital capacity, forced exspiratory volume at one second and oxygenation; however, it was independent from parenchymal abnormalities. The influence of power of breathing on VC and FEV1 and its correlation with RVSP should be evaluated in a prospective trial.

 
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