慢性阻塞性肺疾病伴肺动脉高压患者纤溶状态的探讨

Study on the fibrinolytic status in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

目的:探讨纤溶活性异常与慢性阻塞性肺疾病合并肺动脉高压的关系。方法:收治AECOPD患者84例,其中单纯AECOPD患者52例(不伴PAH组),AECOPD伴肺动脉高压患者32例(伴PAH组),COPD缓解期患者26例(缓解期组)。测定各组患者血浆中t-PA、PAI-1、D-二聚体、FIB的含量。结果:不伴PAH组和伴PAH组患者血t-PA、PAI-1、D-二聚体、FIB较COPD缓解期组明显升高,差异均有统计学意义(P<0.01)。伴PAH组患者血t-PA、PAI-1、D-二聚体、FIB较不伴PAH组明显升高,差异有统计学意义(P<0.01)。血浆D-二聚体水平与肺动脉收缩压呈正相关。结论:无论是不伴肺动脉高压的AECOPD患者,还是伴肺动脉高压的AECOPD患者,循环中均存在纤溶系统异常。D-二聚体水平可在一定程度上反映和估测AECOPD患者肺动脉压力的升高及其程度。

Objective:To investigate the relationship between abnormal fibrinolytic activity and chronic obstructive pulmonary disease with pulmonary hypertension.Methods:84 patients with AECOPD were enrolled,including 52 patients with simple AECOPD(the group without PAH),AECOPD accompanied by pulmonary hypertension in 32 patients(the PAH group),and 26 patients with COPD remission(the remission group).The levels of t-PA,PAI-1,D-dimer,FIB and in the plasma of each group were measured.Results:The serum t-PA,PAI-1,D-dimer and FIB in the group without PAH and the PAH group were significantly higher than those in the remission group,and the differences were statistically significant(P<0.01).The levels of t-PA,PAI-1,D-dimer and FIB in the PAH group were significantly higher than those in the group without PAH,and the difference was statistically significant(P<0.01).The level of plasma D-dimer was positively correlated with the systolic pressure of pulmonary artery.Conclusion:In patients with AECOPD who are not associated with pulmonary hypertension,or in patients with AECOPD with pulmonary hypertension,there are fibrinolytic abnormalities in the circulation.D-dimer levels can reflect and estimate the increase in pulmonary arterial pressure in patients with AECOPD and its extent.