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Eur Respir J :COMPERA 2.0:改良的肺动脉高压四层风险评估模型

2021-11-07 刘少飞 MedSci原创

风险分层在肺动脉高压 (PAH) 患者的管理中起着至关重要的作用。当前的欧洲指南提出了一个 3 层模型,根据预期的 1 年死亡率将风险分类为低、中或高。我们研究了一种基于 4 个风险类别的改进方法,

风险分层已成为肺动脉高压 (PAH) 患者管理的一个组成部分。 欧洲心脏病学会 (ESC) 和欧洲呼吸学会 (ERS) 的 2015 年联合肺动脉高压 (PH) 指南提出了基于9 个评估的 14 个变量的多维风险分层模型。根据该模型,风险分为低、中或高 3 个层次,估计 1 年死亡率分别<5%、5-10% 和 >10%。 建议将实现并保持低风险作为 PAH 患者的治疗目标。

自从这些指南发布以来,几项基于注册表的研究表明,ESC/ERS 工具的简化版本提供了可靠的预测。 特别是,功能分类 (FC)、6 分钟步行试验 (6MWT) 和脑钠肽 (BNP) 或 pro-BNP 的 N 端片段 (NT-proBNP) 的组合被发现具有很强的预后价值, 在诊断时,甚至在随访时,即在开始靶向治疗后。 这些变量也是美国开发的风险分层工具 REVEAL 风险计算器 Lite-2 版本中最可靠的预测参数。

基于这些研究,FC、6MWD 和 BNP/NT-proBNP 已被确定为当前 PAH 风险评估工具的关键要素。然而,SPAHR 和 COMPERA 分析指出,大多数患者在接受 PAH 治疗时不符合低风险标准。事实上,大多数患者符合中等风险标准(基线时约为 70%,随访时约为 60%)。在这些患者中,需要更精细的风险预测,特别是对于影响深远的治疗决策,包括需要肠外前列腺素治疗和肺移植评估。几位研究人员表明,使用来自超声心动图、右心导管插入术或血气分析的其他变量可以改善风险预测。作为替代模型,SPAHR 小组最近提议修改其原始方法,将 1.5-1.99 的计算得分定义为中低风险,将 2.0-2.4 的得分定义为中高风险。尽管基于相对较小的样本量,但这种方法显示出有希望的结果,在中等风险组中进一步区分。

假设基于 6MWD、FC 和 BNP/NTproBNP 的截止水平内的更多粒度的 4 风险分层细分(低、中低、中高和高)可能会改善风险分层。 在这里,使用 COMPERA 数据库来研究使用修改的截止水平的精细风险分层模型 (COMPERA 2.0),其中一些是最近由 REVEAL 小组提出的。

研究方法:

该研究分析了来自欧洲肺动脉高压登记处 COMPERA 的数据,并根据功能等级 (FC)、6 分钟步行距离 (6 MWD) 和脑钠肽 (BNP) 血清水平计算了诊断和首次随访的风险或 pro-BNP (NT-proBNP) 的 N 端片段,使用精确的截止值。

研究入选1655 名 PAH 患者的数据,生存率通过 Kaplan-Meier 分析、对数秩检验和 Cox 比例风险模型进行评估。

研究结果:

使用 3 层模型,大多数患者被归类为中等风险(基线时为 76.0%,第一次随访时为 63.9%)。改进的 4 层风险模型产生了更细微的分离并预测了长期生存,尤其是在后续评估中。 31.1% 的 3-strata 模型患者和 49.2% 的 4-strata 模型患者观察到从基线到随访的风险变化。这些变化,包括中低和中高层之间的变化,与长期死亡风险的变化有关。

研究启示:

与原始 3 层模型相比,基于 FC、6MWD 和 BNP/NT-proBNP 的精确临界值使用 4 层模型修改的风险分层对风险的预后相关变化更敏感。

 

参考文献:

Hoeper MM, Pausch C, Olsson KM, Huscher D, Pittrow D, Grünig E, Staehler G, Vizza CD, Gall H, Distler O, Opitz C, Gibbs JSR, Delcroix M, Ghofrani HA, Park DH, Ewert R, Kaemmerer H, Kabitz HJ, Skowasch D, Behr J, Milger K, Halank M, Wilkens H, Seyfarth HJ, Held M, Dumitrescu D, Tsangaris I, Vonk-Noordegraaf A, Ulrich S, Klose H, Claussen M, Lange TJ, Rosenkranz S. COMPERA 2.0: A refined 4-strata risk assessment model for pulmonary arterial hypertension. Eur Respir J. 2021 Nov 4:2102311. doi: 10.1183/13993003.02311-2021. Epub ahead of print. PMID: 34737226.

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    2022-06-17 soongzhihua
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    2022-09-13 feather89
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    2021-11-07 查查佳佳

    届医学市场年会持续三天,有超过百个主题内

    0

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肺动脉去神经支配术 (PADN) 尚未应用于肺动脉内膜切除术 (PEA) 后残留慢性血栓栓塞性肺动脉高压 (CTEPH) 的患者。本研究将评估PEA后残留的CTEPH远期安全性及有效性。

肺动脉高压的蛋白质组学研究

肺动脉高压(PAH)是一种罕见但致命的心血管疾病,发病率和死亡率都很高。于 PAH 中蛋白质组学生物标志物和潜在分子机制及其对疾病管理价值的文献,旨在加深我们对该疾病的理解,并最终为临床应用铺平道路。

肺动脉高压中肺血管钙化现象

肺动脉高压(PAH)的特征是肺动脉平滑肌细胞(PASMC)过度增殖。尚不清楚RUNX2在PAH相关血管重塑中的意义以及PAH中钙化病变的存在。

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