常规肺功能检查对COPD相关性肺动脉高压的筛查和评估价值

The value of routine pulmonary function in screening and evaluating COPD with pulmonary hypertension

目的探讨常规肺功能检查(PFT)在慢性阻塞性肺疾病(COPD)中筛査和评估肺动脉高压(PH)的价值。方法回顾性分析2008年12月至2018年3月在同济大学附属上海市肺科医院行右心导管检查(RHC),且在检査2周内行PFT的92例COPD患者。收集相关基线资料:人口学特征、PFT、超声心动图、RHC等。采用独立样本t检验和X^2检验等比较基线资料;采用单因素和多因素logistic回归分析寻找预测COPD相关PH (COPD-PH)的PFT参数.并构建PFT预测指数(PFP1)用于筛查COPI>PH0采用受试者工作(R()C)曲线寻找PFPI最优界值。采用Spearman相关分析PFT与COPD-PH严重程度的相关性。结果92例患者中 COPD 不合并 PH (COPD-nonPH) 33 例,COPD-PH 59 例,其中轻度 COPD-PH 28 例(男21例),严重COPD-PH 31例(男21例)。根据多因素logistic回归分析结果构建PFPI计算公式.并采用R()C曲线(AUC = 0.78, 95% CI : 0.67~0.89, P<0.01)计算得PFPI的最优界值为0.53 (敏感度68%,特异度81%)。Spearman相关分析COPD-P H患者中肺--氧化碳弥散量(DlCO)( r=0.52, P=0.01)、DLCO 占预计百分比(r=0.68, P<0.01)与 CI呈正相关。结论 PFPI预测COPD-PH敏感度可,特异度髙,可在COPD患者中早期筛查COPI>PH;COPH-PH患者中DLCO与CI呈中度相关.DLCO越差,提示心脏泵功能越差。

Objective To explore the value of routine pulmonary function test ( PFT) in screening and evaluating pulmonary hypertension ( PH ) in patients with chronic obstructive pulmonary disease ( COPD). Methods 92 patients with COPD who underwent right cardiac catheterization (RHC) in Shanghai Pulmonary Hospital from December 2008 to March 2018 and underwent PFT within 2 weeks of catheterization were retrospectively analyzed. Baseline data were collected, including demographic characteristics, PFT, echocardiography ( Echo), RHC, and so on. Independent-samples t test and X2 test were used to compare the baseline. Univariate and multivariate logistic regression analysis were used to choose the PFT parameters predicting COPD related PH (COPD-PH). PFT prediction index ( PFPI) was constructed for COPD-PH screening. The receiver operating curve ( ROC) was used to find the optimal cutoff value of PFPI. The correlation between PFT and the severity of COPD-PH was analyzed by Spearman correlation. Results There were 33 patients COPD without PH (COPD-nonPH) among 92 patients, 59 were COPD-PH,of which, 28 were mild COPD-PH (21 males), 31 severe COPD-PH (21 males). The formula of PFPI was constructed according to the results of multivariate logistic regression analysis. Based on the receiver operating curve (AUC = 0.78,95% CI : 0.67-0.89, P VO. 01), the optimal cutoff value of PFPI was 0. 53 ( sensitivity 68%, specificity 81%). Among COPD-PH, diffusion capacity for carbon monoxide of the lung ( DLCO)(r=0.52, P <C 0.01 ), I)i.CO percentage of predicted value (r= 0.68, P V0.01) were positively correlated with cardiac index. Conclusions PFPI has good sensitivity and high specificity, and should be used to screening COPDPH in COPD patients. There is a significant association between DLCO and CI in COPD-PH, indicating the lower DLCO is, the worse cardiac pump function is.