动脉血乳酸与老年慢性阻塞性肺疾病相关肺动脉高压的相关性研究

Correlation between Arterial Blood Lactic Acid and Pulmonary Hypertension Related to Chronic Obstructive Pulmonary Disease in Elderly Patients

目的探讨动脉血乳酸与老年慢性阻塞性肺疾病(COPD)相关肺动脉高压的相关性,以明确动脉血乳酸在COPD相关肺动脉高压诊治中的临床意义。方法选择100例COPD急性加重(AECOPD)患者,所有患者入院后心脏彩超检查肺动脉收缩压(PASP)均>50 mm Hg。100例患者中男59例,女41例,患者入院后测定动脉血气(包括乳酸等)、进行心脏彩超检查和CAT问卷评分,治疗10 d后复查上述指标,再根据PASP值大小将100例患者分为观察I组(42例,PASP>40 mm Hg)和观察II组(58例,PASP≤40 mm Hg),治疗前和治疗后检测并比较2组动脉血乳酸、CAT问卷评分、pH值、PaO_2、PaCO_2和氧合指数(PaO_2/FiO_2)等数值间的差异,并计算动脉血乳酸与其他指标值的相关系数,分析其相关性。结果治疗前2组动脉血乳酸、PASP、CAT评分、pH值、PaO_2、PaCO_2和PaO_2/FiO_2等数值间均无明显差异(均P>0.05);与治疗前比较,治疗后观察I组上述指标数值间的差异无统计学意义(P均>0.05),而治疗后观察II组上述指标数值间的差异显著(均P<0.05)。治疗后2组上述指标数值之间的差异均有统计学意义(均P<0.05)。治疗前和治疗后2组动脉血乳酸与pH值、PaO_2及PaO_2/FiO_2均呈负相关性(均P<0.05),而与PASP、PaCO_2及CAT评分均呈正相关性(P均<0.05)。结论动脉血乳酸与老年COPD相关肺动脉高压有一定的相关性,可能具有临床诊治参考价值。

Objective To investigate the correlation between arterial lactate and pulmonary hypertension associated with chronic obstructive pulmonary disease （COPD） in elderly patients. Methods 100 patients with acute exacerbation of COPD （AECOPD）, including 59 males and 41 females, were selected and the echocardiography after admission showed their pulmonary artery systolic pressure （PASP） 〉50mmHg; arterial blood gas analysis （include lactate acid）, echocardiography and CAT （COPD Assessment Test） before treatment and 10 days after treatment were performed on all the patienb^ cording to the PASP results, the patients were divided into group A （42 cases, PASP 〉40 mmHg） and group B （58 cases, PASP 40 mmHg）; the detection results of arterial blood lactic acid, the scores of COPD Assessment Test, arterial blood pH, PaO2, PaCO2, and oxygenation index （PaO2/FiO2） of the patients in the 2 groups before and after treatment were compared; the correlation coefficient of arterial blood lactic acid and other index in the 2 groups before and after treatment was calculated and the correlation was analyzed. Results There existed no statistical difference in arterial blood lactic acid, PASP, CAT,arterial blood pH, PaO2, PaCO2and PaO2/FiO2 before treatment between the 2 groups （al lP〈0.05）; the above indexes of the patients in group A after treatment were of no statistical dif-ference from those before treatment （all P 〈 0.05） while the above indexes of the patients in group B after treatment were obviously different from those before treatment （all P 〉 0.05）; the difference in above indexes after treatment between the 2groups was of statistical significance （P〉0.05）; before and after treatment, the arterial blood lactate acid of the patients in both group was in negative correlation with pH, PaO2 and PaO2/FiO2 but in positive correlation with PASP, PaCO2 and CAT （all P〈0.05）. Conclusion Arterial blood lactate acid is of certain correlation with COPD related pulmonary hypertension in elderly patients, which may be of reference value in clinical diagnosis and treatment.