慢性阻塞性肺疾病合并“不成比例”肺动脉高压与血CRP、D-二聚体水平的相关性

Relationship between the concentration of serum CRP,plasma D-Dimer and out-of-proportion pulmonary hypertension in COPD

目的探讨慢性阻塞性肺病（COPD）患者C-反应蛋白（CRP）、D-二聚体水平与＂不成比例＂肺动脉收缩压之间的关系。方法 2011年6月-2013年6月COPD因急性发作住院患者常规查心脏彩超、测肺动脉收缩压和肺功能,检测外周血血清CRP、血浆D-二聚体水平。选取46例存在＂不成比例＂肺动脉高压（PAH）COPD患者为研究对象,另选40例常规PAH为对照组。结果 ＂不成比例＂PAH组和常规PAH组在COPD急性期CRP及D-二聚体水平均明显高于其正常值,但两组均无明显差异（P〉0.05）;COPD缓解期＂不成比例＂组D-二聚体水平均明显高于常规组（P〈0.05）;而缓解期＂不成比例＂组CRP水平与常规组无明显差异（P〉0.05）。结论 COPD患者存在系统性炎症和血液高凝状态,是导致和加重COPD患者PAH的重要因素,CRP、D-二聚体作为分别体现系统性炎症和血液高凝状态的主要指标,COPD缓解期高水平的D-二聚体可在一定程度上反映＂不成比例＂PAH存在,而CRP与＂不成比例＂PAH无明显相关性。

Objective To analyze the relationship between CRP,D-Dimer and out-of-proportion pulmonary hypertension in chronic obstructive pulmonary disease. Methods Pulmonary artery pressure levels assessed by echocardiography and lung function were measured regularly in patients with acute exacerbations of COPD from June 2011 to June 2013. Serum CRP and plasma DDimer levels from 46 patients with out-of-proportion pulmonary hypertension（PAH） and 40 patients with the routine PAH were de tected in the acute exacerbations and remission of COPD. Results CRP and D-Dimer levels were higher than their normal values,but there was no significant difference between the group in PAH with out-of-proportion and the control group in acute exacerbations of COPD（P〉 0.05）;D-Dimer level was significantly different between the group in PAH with out-of-proportion and the control group in remission of COPD（P〈 0.05）;CRP level was not significantly different between the group in PAH with out-of-proportion PAH and the control group in remission of COPD（P〉 0.05）. Conclusion COPD is associated with systemic inflammation and hypercoagulable state,which will cause and aggravate pulmonary hypertension. CRP and D-Dimer as markers of systemic inflammation and hypercoagulable state respectively,elevated D-Dimer levels can reflect the presence of out-of-proportion PAH,but CRP level does not related to out-of-proportion PAH.