To the Editor Chack for updates Sarcoidosis is a multisystem inflammatory granulomatous disorder where over 90% of cases involve the lungs.1 A significant complication is sarcoidosis-associated pulmonary hypertension(...To the Editor Chack for updates Sarcoidosis is a multisystem inflammatory granulomatous disorder where over 90% of cases involve the lungs.1 A significant complication is sarcoidosis-associated pulmonary hypertension(SAPH),classified under Group 5 pulmonary hypertension(PH),2 which develops in a substantial proportion of patients,particularly those with advanced pulmonary sarcoidosis,and portends a poor prognosis.展开更多
Background Serum uric acid （UA）, the final product of purine degradation, has been proposed to be a marker for the severity and a possible predictor of mortality in patients with pulmonary arterial hypertension （PA...Background Serum uric acid （UA）, the final product of purine degradation, has been proposed to be a marker for the severity and a possible predictor of mortality in patients with pulmonary arterial hypertension （PAH）. The objectives of this study were to elucidate whether serum UA level correlates with the clinical features and the hemodynamic variables in Chinese patients with PAH and to compare the difference of the correlates in patients associated with different etiologies. Methods Serum UA was assessed in 228 patients with three types of PAH （idiopathic PAH （IPAH）, congenital heart disease related PAH （CHD-PAH） and connective tissue disease related PAH （CTD-PAH）） together with other clinical features. After the individualized treatment for at least 6 months, the UA levels and clinical features were re-evaluated in 88 patients. Results Serum UA was significantly elevated in patients with PAH compared with age-matched control subjects （（350.40±108.73） μmol/L vs （266.91±81.38） μmol/L）, P 〈0.001）. Serum UA negatively correlated with cardiac output and mixed venous saturation （SvO2） in all three types of PAH （all P 〈0.05）, positively correlated with the size of right ventricle in IPAH （P=0.002） and CTD-PAH （P=0.013） patients and with pulmonary vascular resistance just in CTD-PAH patients （P=0.001）. Serum UA significantly decreased from （365.80±120.46） μmol/L to （333.67±117.56） μmol/L in 88 patients （P=0.006） with vasodilator therapy for at least 6 months, accompanied with a reduction in pulmonary vascular resistance from （15.13±6.96） Woods unit to （12.00±5.04） Woods unit （P=0.001） and an increase in cardiac output from （2.63±0.98） L/min to （3.08±1.04） L/min （P=0.005）. Conclusions Serum UA increases in proportion to the clinical severity of all the three types of PAH, especially the CTD-PAH had a stronger correlations compared with IPAH and CHD-PAH. The serum UA levels also could partly reflect the response to the treatment in patients with PAH.展开更多
Background:Coronavirus disease 2019(COVID-19)has potential risks for both clinically worsening pulmonary hypertension(PH)and increasing mortality.However,the data regarding the protective role of vaccination in this p...Background:Coronavirus disease 2019(COVID-19)has potential risks for both clinically worsening pulmonary hypertension(PH)and increasing mortality.However,the data regarding the protective role of vaccination in this population are still lacking.This study aimed to assess the safety of approved vaccination for patients with PH.Methods:In this national prospective cohort study,patients diagnosed with PH(World Health Organization[WHO]groups 1 and 4)were enrolled from October 2021 to April 2022.The primary outcome was the composite of PH-related major adverse events.We used an inverse probability weighting(IPW)approach to control for possible confounding factors in the baseline characteristics of patients.Results:In total,706 patients with PH participated in this study(mean age,40.3 years;mean duration after diagnosis of PH,8.2 years).All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China.Among them,278 patients did not receive vaccination,whereas 428 patients completed the vaccination series.None of the participants were infected with COVID-19 during our study period.Overall,398 patients received inactivated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine,whereas 30 received recombinant protein subunit vaccine.After adjusting for baseline covariates using the IPW approach,the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase(27/428[6.3%]vs.24/278[8.6%],odds ratio=0.72,P=0.302).Approximately half of the vaccinated patients reported at least one post-vaccination side effects,most of which were mild,including pain at the injection site(159/428,37.1%),fever(11/428,2.6%),and fatigue(26/428,6.1%).Conclusions:COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH,although there were some tolerable side effects.A large-scale randomized controlled trial is warranted to confirm this finding.The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.展开更多
文摘To the Editor Chack for updates Sarcoidosis is a multisystem inflammatory granulomatous disorder where over 90% of cases involve the lungs.1 A significant complication is sarcoidosis-associated pulmonary hypertension(SAPH),classified under Group 5 pulmonary hypertension(PH),2 which develops in a substantial proportion of patients,particularly those with advanced pulmonary sarcoidosis,and portends a poor prognosis.
文摘Background Serum uric acid （UA）, the final product of purine degradation, has been proposed to be a marker for the severity and a possible predictor of mortality in patients with pulmonary arterial hypertension （PAH）. The objectives of this study were to elucidate whether serum UA level correlates with the clinical features and the hemodynamic variables in Chinese patients with PAH and to compare the difference of the correlates in patients associated with different etiologies. Methods Serum UA was assessed in 228 patients with three types of PAH （idiopathic PAH （IPAH）, congenital heart disease related PAH （CHD-PAH） and connective tissue disease related PAH （CTD-PAH）） together with other clinical features. After the individualized treatment for at least 6 months, the UA levels and clinical features were re-evaluated in 88 patients. Results Serum UA was significantly elevated in patients with PAH compared with age-matched control subjects （（350.40±108.73） μmol/L vs （266.91±81.38） μmol/L）, P 〈0.001）. Serum UA negatively correlated with cardiac output and mixed venous saturation （SvO2） in all three types of PAH （all P 〈0.05）, positively correlated with the size of right ventricle in IPAH （P=0.002） and CTD-PAH （P=0.013） patients and with pulmonary vascular resistance just in CTD-PAH patients （P=0.001）. Serum UA significantly decreased from （365.80±120.46） μmol/L to （333.67±117.56） μmol/L in 88 patients （P=0.006） with vasodilator therapy for at least 6 months, accompanied with a reduction in pulmonary vascular resistance from （15.13±6.96） Woods unit to （12.00±5.04） Woods unit （P=0.001） and an increase in cardiac output from （2.63±0.98） L/min to （3.08±1.04） L/min （P=0.005）. Conclusions Serum UA increases in proportion to the clinical severity of all the three types of PAH, especially the CTD-PAH had a stronger correlations compared with IPAH and CHD-PAH. The serum UA levels also could partly reflect the response to the treatment in patients with PAH.
基金supported by the National Key Research and Development Program of China(No.2022YFC2703902)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Nos.2020-I2MC&T-B-003,2021-I2M-1-018)the National High Level Hospital Clinical Research Funding(No.2022-PUMCH-B-099).
文摘Background:Coronavirus disease 2019(COVID-19)has potential risks for both clinically worsening pulmonary hypertension(PH)and increasing mortality.However,the data regarding the protective role of vaccination in this population are still lacking.This study aimed to assess the safety of approved vaccination for patients with PH.Methods:In this national prospective cohort study,patients diagnosed with PH(World Health Organization[WHO]groups 1 and 4)were enrolled from October 2021 to April 2022.The primary outcome was the composite of PH-related major adverse events.We used an inverse probability weighting(IPW)approach to control for possible confounding factors in the baseline characteristics of patients.Results:In total,706 patients with PH participated in this study(mean age,40.3 years;mean duration after diagnosis of PH,8.2 years).All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China.Among them,278 patients did not receive vaccination,whereas 428 patients completed the vaccination series.None of the participants were infected with COVID-19 during our study period.Overall,398 patients received inactivated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine,whereas 30 received recombinant protein subunit vaccine.After adjusting for baseline covariates using the IPW approach,the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase(27/428[6.3%]vs.24/278[8.6%],odds ratio=0.72,P=0.302).Approximately half of the vaccinated patients reported at least one post-vaccination side effects,most of which were mild,including pain at the injection site(159/428,37.1%),fever(11/428,2.6%),and fatigue(26/428,6.1%).Conclusions:COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH,although there were some tolerable side effects.A large-scale randomized controlled trial is warranted to confirm this finding.The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.
