肺动脉高压中肾功能与糖尿病重叠的临床特征与预后
该回顾性国际队列纳入2001—2023年新诊断肺动脉高压患者555例，42%（234例）合并慢性肾病和/或糖尿病，定义为肾-糖尿病重叠。此类患者基线病情更重、9个月时更高比例处于高/中高危，随访中全因死亡或PAH住院及全因死亡风险均显著升高。
要点
- PAH患者中肾-糖尿病重叠常见（42%），基线功能状态与风险分层更差。
- 重叠患者全因死亡或PAH住院风险升高（HR 1.45），全因死亡风险亦升高（HR 1.47）。
- 重叠患者内皮素受体拮抗剂使用较少，9个月时高/中高危比例显著更高。
核心结论
- PAH合并肾-糖尿病重叠较常见，存在未满足的治疗需求且结局更差。
研究设计与样本
- 回顾性分析2001—2023年诊断的555例新发PAH国际队列，均有结局数据，CKD和/或DM定义为肾-糖尿病重叠。
主要发现
- 234例（42%）为肾-糖尿病重叠：45例DM、135例CKD、54例两者兼有。
- 重叠患者36% vs 26%被评估为高死亡风险（p<0.01）。
- 诊断时重叠患者内皮素受体拮抗剂治疗较少（61% vs 69%，p=0.04），单药治疗较多（55% vs 45%，p=0.06）。
- 9个月时重叠患者高或中高危分别为19%和32%，非重叠患者为4%和23%（p<0.001）。
- 随访2.5（1-5）年，全因死亡/PAH住院HR 1.45（95%CI 1.07-1.98，p=0.02），全因死亡HR 1.47（95%CI 1.05-2.04，p=0.02）。
临床怎么用
- 对PAH患者应评估肾功能与糖尿病状态，识别肾-糖尿病重叠高危人群并加强风险分层与随访。
局限性
- 为回顾性研究，可能存在选择偏倚与残余混杂，治疗模式差异非随机比较。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Comorbidities add complexity to pulmonary arterial hypertension (PAH), but also open opportunities to use therapies with benefits beyond the cardiovascular (CV) system, particularly preserving renal function and maintaining glucose homeostasis. METHODS: We retrospectively analysed an international cohort of incident patients with PAH diagnosed in 2001-2023, with available outcome data. Patients with chronic kidney disease (CKD) and/or diabetes mellitus (DM) were defined as renal-diabetic (RD). The relationship between RD overlap, all-cause mortality (ACM) or PAH hospitalisation or ACM alone was assessed by Kaplan-Meier curves and Cox proportional hazard regression. RESULTS: Of 555 eligible subjects, 234 (42%) were classified as RD: 45 had DM, 135 CKD and 54 both. At baseline, RD patients were older and had greater comorbidity burden, higher WHO functional class and higher pulmonary artery wedge pressure than non-RD patients; 36% vs 26% (p<0.01) were estimated at high mortality risk. On PAH diagnosis, RD patients were less treated with endothelin receptor antagonists (61% vs 69%, p=0.04) and more with single PAH therapy (55% vs 45%, p=0.06). After 9 months, treatment patterns were similar, but 19% and 32% of RD patients were at high or intermediate-high risk, respectively, as compared with 4% and 23% of non-RD patients (p<0.001).During a follow-up of 2.5 (1-5) years, ACM/PAH hospitalisation and ACM alone were more frequent in RD patients than non-RD patients, with HR 1.45 (95% CI 1.07 to 1.98, p=0.02) and HR 1.47 (95% CI 1.05 to 2.04, p=0.02), respectively. CONCLUSION: PAH with RD overlap is common, and has unmet therapeutic needs and worse outcomes.
引用
- Toma M, Vani S, Savonitto G, et al. Renal-diabetic overlap in pulmonary arterial hypertension. Heart. 2026. PMID: 42185040. doi:10.1136/heartjnl-2025-327389
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。