RDW联合血浆ET-1对COPD急性加重期并发肺动脉高压的预测分析

Prediction of acute exacerbation COPD complicated with pulmonary hypertension by RDW combined with plasma ET-1

目的探讨红细胞分布宽度(RDW)联合血浆内皮素-1(ET-1)对慢性阻塞性肺疾病(COPD)急性加重期并发肺动脉高压(PH)的预测价值。方法连续收集2015年7月至2018年12月重庆市梁平区人民医院呼吸内科收治的急性加重期慢性阻塞性肺疾病患者(AECOPD组)67例,门诊同期随诊稳定期COPD患者(COPD组)72例,另取同期正常健康体检者75例为对照组。采用全自动生化仪检测受试者RDW比例及血浆ET-1水平。Logistic回归分析影响AECOPD患者发生PH的危险因素;绘制受试者工作特征曲线(ROC),分析RDW、血浆ET-1水平及二者联合检测对AECOPD并发PH的预测价值。结果对照组、COPD组、AECOPD组患者年龄、性别、吸烟比例、心率比较,差异无统计学意义(P>0.05);与对照组比较,COPD组、AECOPD组患者肺动脉收缩压(PASP)、动脉二氧化碳分压(PaCO2)、RDW比例、血浆ET-1水平依次升高,动脉血氧分压(PaO2)、1 s用力呼气容积(FEV1)、1 s用力呼气容积/用力肺活量(FEV1/FVC依次)降低,差异均有统计学意义(P均<0.05)。AECOPD并发PH患者PaCO2、RDW比例、血浆ET-1水平为(61.38±12.15)mm Hg、(15.43±2.74)%、(67.75±10.41)ng/L,显著高于单纯AECOPD组患者(55.43±11.04)mm Hg、(14.11±2.32)%、(62.32±8.59)ng/L;PaO2、FEV1、FEV1/FVC分别为(51.75±10.43)mm Hg、(37.04±7.41)%、(32.58±6.52)%,显著低于单纯AECOPD组患者(62.67±12.54)mm Hg、(41.32±8.26)%、(36.79±7.36)%,差异均有统计学意义(P<0.05)。Logistic回归分析显示,PASP、RDW及血浆ET-1水平是影响AECOPD并发PH的危险因素(P均<0.05)。RDW、血浆ET-1联合诊断AECOPD并发PH的曲线下面积(AUC)为0.904,高于二者单独检测(AUC分别为0.753、0.752),灵敏度为74.40%,特异度为94.40%。结论AECOPD并发PH患者RDW比例、血浆ET-1水平显著升高,二者联合检测可能对AECOPD并发PH有一定预测价值。

Objective To study the predictive value of red cell distribution width(RDW)combined with plasma endothelin-1(ET-1)in acute exacerbation of chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH).Methods From July 2015 to December 2018,67 patients with acute exacerbated chronic obstructive pulmonary disease,72 patients with stable COPD in the same period of outpatient follow-up,and 75 healthy people in the same period were selected as the AECOPD group,COPD group and control group,respectively.All subjects were examined routinely and fasting venous blood was collected in the morning.The RDW ratio and plasma ET-1 level were measured by automatic biochemical analyzer.Logistic regression analysis was used to analyze the risk factors of PH in AECOPD patients;the receiver operating characteristic curve(ROC)of subjects was drawn;the predictive values of RDW,plasma ET-1 level and combined detection of RDW and ET-1 in AECOPD complicated with PH were analyzed.Results There was no significant difference in age,sex,smoking rate and heart rate between control group,COPD group and AECOPD group(P>0.05).Compared with the control group,the pulmonary arterial systolic pressure(PASP),arterial partial pressure of carbon dioxide(PaCO2),RDW ratio and plasma ET-1 level in COPD group and AECOPD group increased in turn(P<0.05),while arterial partial pressure of oxygen(PaO2),FEV1 and FEV1/FVC decreased in turn(P<0.05).The levels of PaCO2,RDW ratio and plasma ET-1 were higher in AECOPD complicated with PH group[(61.38±12.15)mm Hg,(15.43±2.74)%,(67.75±10.41)ng/L,respectively]than in the AECOPD group[(55.43±11.04)mm Hg,(14.11±2.32)%,(62.32±8.59)ng/L,respectively],while the levels of PaO2,FEV1,FEV1/FVC[(51.75±10.43)mm Hg,(37.04±7.41)%,(32.58±6.52)%,respectively]were lower in the AECOPD complicated with PH group than that in the AECOPD group[(62.67±12.54)mm Hg,(41.32±8.26)%,(36.79±7.36)%,respectively],and all the differences were statistically significant(all P<0.05).Logistic regression analysis showed that PASP,RDW and plasma ET-1 levels were risk factors for PH in patients with AECOPD(all P<0.05).The results of ROC analysis showed that the area under curve(AUC)of combined RDW and plasma ET-1 in the diagnosis of PH in AECOPD patients was 0.904,which was significantly higher than that of single detection(AUC was 0.753 and 0.752,respectively),with sensitivity of 74.40%and specificity of 94.40%.Conclusion The ratio of RDW and the level of plasma ET-1 in patients with AECOPD complicated with PH were significantly increased,and the combined detection of RDW and plasma ET-1 may had some predictive value for AECOPD complicated with PH.