慢性阻塞性肺疾病合并肺动脉高压患者的临床特征与危险因素分析

Clinical features and risk factors of patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

目的探讨慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者的临床特征及相关危险因素。方法回顾性分析2015年1月至2016年1月自贡市第四人民医院呼吸科住院COPD患者702例,根据是否并发PH分为PH组279例和无PH组423例,PH组患者根据收缩期肺动脉压(SPAP)又分为轻度PH亚组188例和重度PH亚组91例,分别比较PH组和无PH组以及亚组患者间的体质量指数(BMI)、B型脑钠肽(BNP)、红细胞沉降率(ESR)、红细胞压积(HCT)、C-反应蛋白(CRP)、白蛋白(ALB)、氧合指数(OI)、D-二聚体(D-D)、纤维蛋白原(FIB)、乳酸(LA)、第1秒用力呼气末容积(FEV1)和糖类抗原125(CA125)的差异。利用SPSS 18.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。Pearson相关分析SPAP的影响因素,采用多因素logistic回归分析危险因素。结果PH组患者相比无PH组患者FEV1/预计值[(46.4±16.5)%vs(67.6±15.4)%]和OI值[(226.7±56.9)vs(352.0±49.9)mmHg(1 mmHg=0.133 k Pa)]下降,BNP[(575.9±53.2)vs(297.8±84.8)pg/ml]、CA125[(39.9±14.5)vs(15.8±12.2)U/L]和SPAP[(59.2±16.3)vs(30.4±9.1)mmHg]增高,差异具有统计学意义(P<0.05)。重度相比轻度PH组患者FEV1/预计值[(37.4±16.7)%vs(59.8±14.1)%]和OI值[(156.0±80.5)vs(267.7±98.9)mmHg]下降,BNP[(698.0±125.6)vs(495.9±118.2)pg/ml]、D-D[(2.9±1.2)vs(1.3±1.2)mg/L]、FIB[(4.9±1.4)vs(3.7±1.5)g/L]、LA[(3.5±1.8)vs(1.8±1.1)mmol/L]、CA125[(52.8±38.2)vs(32.9±17.5)U/L]和SPAP[(68.3±16.1)vs(55.2±14.3)mmHg]增高,差异具有统计学意义(P<0.05)。Pearson相关分析结果表明SPAP与OI(r=-0.459,P=0.021)、FEV1/预计值呈负相关(r=-0.442,P=0.035),与BNP(r=0.507,P=0.012)、CA125(r=0.375,P=0.048)和D-D(r=0.401,P=0.030)呈正相关。多因素logistic回归分析结果表明BNP、CA125、D-D、FEV1/预计值和OI是PH的危险因素。结论 PH是COPD患者常见并发症,检测BNP、CA125、D-D、FEV1/预计值和OI等指标有助于临床诊疗。

Objective To investigate the clinical features and related risk factors of chronic obstructive pulmonary disease（ COPD）complicated with pulmonary hypertension（ PH）. Methods A retrospective analysis was carried out on 702 COPD patients admitted to our department of respiratory diseases from January 2015 to January 2016. According to complicated with PH or not,they were assigned into PH group（ n = 279） and non-PH group（ n = 423）. The former group was further divided into mild PH subgroup（ n = 188） and severe PH subgroup（ n = 91） based on their systolic pulmonary arterial pressure（ SPAP）. Body mass index（ BMI）,type B brain natriuretic peptide（ BNP）,erythrocyte sedimentation rate（ ESR）,hematocrit（ HCT）,C-reactive protein（ CRP）,albumin（ ALB）,oxygenation index（ OI）,D-dimer（ D-D）,fibrinogen（ FIB）,lactic acid（ LA）,first second forced expiratory volume（ FEV1） and carbohydrate antigen 125（ CA125） were compared between the PH and non-PH groups and between the mild PH and severe PH subgroups. SPSS statistics 18. 0 was used to analyze the data. Student＇ s t test or Chi-square test was employed for the comparison between groups. Pearson correlation analysis was used for the influencing factors for SPAP,and multivariate logistic regression analysis for risk factors. Results Compared with the non-PH patients,the PH patients had significantly lower FEV1/predictive value[（ 46. 4 ±16. 5） % vs（ 67. 6 ±15. 4） %]and OI [（ 226. 7 ±56. 9） vs（ 352. 0 ±49. 9） mmHg],and increased BNP [（ 575. 9 ±53. 2） vs（ 297. 8 ± 84. 8） pg/ml],CA125 [（ 39. 9 ± 14. 5） vs（ 15. 8 ± 12. 2） U/L] and SPAP [（ 59. 2 ± 16. 3） vs（ 30. 4 ± 9. 1） mmHg]（ all P〈0. 05）. The ratio of FEV1/predictive value [（ 37. 4 ± 16. 7） % vs（ 59. 8 ± 14. 1） %] and OI [（ 156. 0 ± 80. 5） vs（ 267. 7 ± 98. 9） mmHg] were obviously higher,while the levels of BNP [（ 698. 0 ± 125. 6） vs（ 495. 9 ± 118. 2） pg/ml],D-D[（ 2. 9 ± 1. 2） vs（ 1. 3 ± 1. 2） mg/L],FIB [（ 4. 9 ± 1. 4） vs（ 3. 7 ± 1. 5） g/L],LA [（ 3. 5 ± 1. 8） vs（ 1. 8 ± 1. 1） mmol/L],CA125[（ 52. 8 ± 38. 2） vs（ 32. 9 ± 17. 5） U/L],and SPAP[（ 68. 3 ± 16. 1） vs（ 55. 2 ± 14. 3） mmHg]were elevated in the severe PH group than the mild PH group（ all P〈0. 05）. Pearson correlation analysis showed that SPAP was negatively correlated with OI（ r =-0. 459,P = 0. 021） and FEV1/predictive value（ r =-0. 442,P = 0. 035）,and positively correlated with BNP（ r = 0. 507,P = 0. 012）,CA125（ r = 0. 375,P = 0. 048） and D-D（ r = 0. 401,P = 0. 030）. Multivariate logistic regression analysis indicated that BNP,CA125,D-D,FEV1/predictive value and OI were risk factors for PH. Conclusion PH is a common complication of COPD. The detection of BNP,CA125,D-D,FEV1/predictive value and OI is helpful to its diagnosis and treatment.