An opportunity to improve pulmonary capillary circulation in patients with chronic obstructive pulmonary disease and comorbidity

This study was aimed at investigating pathogenesis of pulmonary vascular abnormalities in COPD with systemic features, and ways to treat these circulatory disorders. Methods. We analyzed pulmonary vascular parameters, molecular markers of endothelial dysfunction, pulmonary artery pressure (PAP) and gas exchange in patients with moderate (n = 64) and severe (n = 70) COPD treated with basic therapy with or without an endothelial protector. Results. The results showed that perfusion disorders could appear in different parts of the lungs, probably, due to different mechanisms of these abnormalities. Localization of perfusion disorders was related to blood levels of molecular markers of endothelial dysfunction: adhesion molecules sP-selectin and sVCAM-1 were related to perfusion abnormalities in the upper lobes, VEGF-A was related to perfusion abnormalities in the lower lobes, and diffuse perfusion abnormalities were related to endothelin-1. Additional treatment with sulodexide improved endothelial function and pulmonary circulation, decreased PAP and blood concentrations of molecular markers of endothelial dysfunction. Conclusion. Predominant localization of microcirculatory abnormalities in COPD patients, especially in the lower lobes, is related to ventilation abnormalities, could predict clinical course of the disease and indicates the need in endotheliotropic therapy.

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