老年慢性阻塞性肺疾病相关肺动脉高压患者血浆胃促生长素的变化特征与临床应用价值研究

Study on the Changes and Clinical Value of Plasma Ghrelin in the Elderly with Pulmonary Arterial Hypertension Related to Chronic Obstructive Pulmonary Disease

目的探讨胃促生长素(Ghrelin)在老年慢性阻塞性肺疾病相关肺动脉高压(COPD-PAH)患者血浆中的变化特征,为明确其在COPD-PAH诊治中的价值提供依据。方法对80例COPD急性加重期患者的资料进行回顾性分析,其中男性47例,女性33例,年龄65~79岁,年龄中位数为71.5岁。入院后治疗前所有患者心脏彩超检查肺动脉收缩压(PASP)均>50 mmHg,同时测定患者血浆Ghrelin和IL-6浓度,进行动脉血气分析、心脏彩超和CAT问卷评分。所有患者均给予吸氧、抗感染、解痉、平喘和祛痰等治疗。治疗10 d后复查上述指标,根据PASP值大小将80例患者分为A组(32例,PASP>40 mmHg)和B组(48例,PASP≤40 mmHg),比较A和B组之间治疗前和治疗后血浆Ghrelin、IL-6、pH值、PaO_2、PaCO_2、氧合指数(PaO_2/FiO_2)和CAT问卷评分等数值的差异,计算2组治疗前和治疗后血浆Ghrelin与其他指标的相关系数,进行相关性分析。结果治疗前2组血浆Ghrelin、IL-6浓度、PASP、pH值、PaO_2、PaCO_2、PaO_2/FiO_2和CAT评分等数值的差异均无统计学意义(均P>0.05);A组治疗前和治疗后上述指标之间的差异无统计学意义(均P>0.05),而B组治疗前和治疗后上述指标之间的差异有统计学意义(均P<0.05)。B组治疗后与A组治疗后比较,上述指标之间的差异有统计学意义(均P<0.05)。治疗前和治疗后2组血浆Ghrelin浓度与pH值、PaO_2及PaO_2/FiO_2均呈正相关性(均P<0.05),与血浆IL-6、PASP、PaCO_2及CAT评分均呈负相关性(均P<0.05)。结论血浆Ghrelin浓度与老年COPD-PAH有一定的相关性,可为其诊治提供参考价值,具有一定的临床意义。

Objective To explore the changes of plasma ghrelin in the elderly patients with pulmonary arterial hypertension related to chronic obstructive pulmonary disease(COPD-PAH).Methods A retrospective analysis was made to the clinical data of80hospitalized patients with acute exacerbation of COPD,including47male and33female,aged from65to79years old with the average of71.5;echocardiography before treatment showed all the patients with PASP>50mmHg;the levels plasma ghrelin and IL-6were detected,and arterial blood gas analysis,echocardiography and CAT questionnaire were performed in all the patients as well as the treatment of oxygen inhalation,anti-infection,spasmolysis,anti-asthma and phlegm expelling;10days after treatment,the above index were detected again and the80patients were divided,according to the PASP values,into2groups:group A(n=32,PASP>40mmHg)and group B(n=48,PASP≤40mmHg);a comparative study was made to the difference in plasma ghrelin,IL-6,pH value,PaO2,PaCO2,oxygenation index(PaO2/FiO2)and CAT questionnaire scores between the2groups,the coefficients of plasma ghrelin and other index before and after treatment were calculated and correlative analysis was performed.Results Before treatment,there existed no statistical difference in plasma ghrelin,IL-6,pH value,PaO2,PaCO2,oxygenation index(PaO2/FiO2)and CAT questionnaire scores between the2groups(P>0.05);the above index in group A were of no statistical difference before and after treatment(P>0.05)while those in group B were of certain statistical difference before and after treatment(P<0.05);the plasma ghrelin concentrations of the patients in both groups before and after treatment were positively correlated to pH value,PaO2and PaO2/FiO2but negatively correlated to IL-6,PASP,PaCO2and CAT questionnaire scores(P<0.05).Conclusions Plasma ghrelin concentration is correlated to COPD-PAH in the elderly,which can provide reference for the diagnosis and treatment with certain clinical significance.