D-二聚体和C反应蛋白在慢性阻塞性肺病进展中的变化及对肺动脉高压严重程度的预测作用

Changes of D-dimer and C-reactive protein in the progression of chronic obstructive pulmonary disease and their predictive effects on the severity of pulmonary hypertension

目的探讨D-二聚体(DD)和C反应蛋白(CRP)在慢性阻塞性肺疾病(COPD)进展中的变化及对肺动脉高压(PH)严重程度的预测作用。方法收集安徽省胸科医院COPD患者150例,其中COPD稳定期组39例,慢性阻塞性肺疾病急性加重组(AECOPD)41例,AECOPD合并PH组70例。另选取同期体检健康者40例作为对照组。AECOPD合并PH组根据PH严重程度可分为轻度组、中度组及重度组。比较对照组与COPD各组的CRP、DD水平,以及AECOPD组与AECOPD合并PH组,AECOPD合并不同严重程度PH亚组在治疗前及治疗4、8、12 d的DD和CRP水平的变化。结果治疗前,COPD组CRP、DD水平高于对照组,且COPD患者CRP、DD水平随病情严重程度而逐渐升高,差异均有统计学意义(FCRP=19.647,FDD=16.598,P<0.05或P<0.01)。治疗4、8、12 d后,AECOPD组与AECOPD合并PH组CRP、DD水平均较同组治疗前降低,且组间同一时间点两两比较差异有统计学意义(FCRP组内/组间=25.251/18.647,FDD组内/组间=6.903/5.412,P<0.05或P<0.01),但AECOPD合并PH组治疗8、12 d的CRP、DD水平差异无统计学意义(P>0.05)。AECOPD合并PH各亚组中,治疗4、8、12 d后CRP、DD水平均较同组治疗前降低(FCRP组内/组间=28.132/19.136,FDD组内/组间=3.521/4.248,P<0.05),但重度组CRP、DD水平仍高于轻度、中度组。线性回归分析显示,DD、CRP与PASP呈正相关(rDD=0.727,rCRP=0.843,P均<0.01)。结论 DD、CRP水平随COPD患者疾病进展而逐渐升高,且与PH严重程度呈正相关,可作为COPD病情进展及PH严重程度的预测指标。

Objective To investigate the dynamic changes of D-dimer （DD） and C-reactive protein （CRP） in the progression of chronic obstructive pulmonary disease （COPD） and their predictive effects on the severity of pulmonary hypertension （PH）. Methods A total of 150 patients with COPD admitted in Anhui Provincial Chest Hospital, including 39 stable COPD patients, 41 acute exacerbated COPD （AEPOCD） patients and 70 COPD patients with PH, and 40 healthy controls were collected. The AECOPD patients with PH were subdivided into mild, moderate and severe groups according to the severity of PH. The levels of plasma DD and serum CRP in dif- ferent groups and subgroups were compared, and the changes of plasma DD and serum CRP levels in AECOPD patients and AECOPD patients with PH before treatment and treating for 4, 8 and 12 days were also compared. Results Before treatment, the levels of serum CRP and plasma DD in the COPD patients were higher than that in the healthy controls, and the serum CRP and plasma DD levels in COPD patients increased with the severity of the disease （FcRP = 19.647, FDD = 16.598, P〈0.05 or P〈0.01）. After treating for 4, 8, and 12 days, the levels of serum CRP and plasma DD in AECOPD patients and AECOPD patients with PH were significantly lower than that before treatment, and there were significant differences between groups （FCRP = 18.647, FDD = 5.412, P〈0.05 or P〈0.01 ） and between intragroups （FCHP = 25.251, FDD =6.903, P〈0.05 or P〈0.01 ）. However, there was no statistical significance in serum CRP and plasma DD levels of AECOPD patients with PH between treating for 8 and 12 days （P〉0.05）. After treating for 4, 8 and 12 days, the levels of serum CRP and plasma DD in AECOPD patients with PH subgroups were significantly lower than that before treatment, and there were significant difference between subgroups （ FCRP= 19.136, FDD = 4.248, P〈0.05） and within subgroups （ FCRP = 28.132, FDD = 3.521 ,P〈0.05）. Moreover, the levels of serum CRP and plasma DD in AECOPD patients with severe PH were still higher than that with mild and moderate PH. The multiple linear regression analysis showed that serum CRP and plasma DD levels were positively correlated with pulmonary artery systolic pressure （PASP） （rDD = 0.727, rCRP = 0.843, P〈0.01）. Conclusion The plasma DD and serumCRP levels increase with the progression of COPD, and are positively correlated with the severity of PH, which may be used as the predictive markers for the progression of COPD and severity of PH.