慢性阻塞性肺疾病急性加重期凝血相关指标与肺动脉高压的关系研究

Correlation between Blood Coagulation Function and Pulmonary Hypertension in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨凝血相关指标在慢性阻塞性肺疾病急性加重期(AECOPD)的改变及与肺动脉高压(PH)的关系.方法选取168例AECOPD患者作为AECOPD组,根据肺动脉收缩压(PASP)分为无PH[≤30 mmHg(4 kPa,1 kPa=7.5 mmHg)]组53例、轻度PH(31~50 mmHg)组42例、中度PH(51~70 mmHg)组38例、重度PH(≥71 mmHg)组35例.选取同期体检健康人50例作为对照组.AECOPD患者治疗后及对照组均检测部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)、内皮素1(ET-1)水平.采用偏相关性分析凝血因子、hs-CRP、ET-1与继发PH的相关性,采用二元logistic回归分析继发PH及血液高凝状态的危险因素.结果AECOPD组患者治疗后APTT、PT水平与治疗前及对照组比较,差异均无统计学意义(P>0.05),D-D、FIB、hs-CRP、ET-1均下降,与治疗前比较差异均有统计学意义(P<0.05).无PH组D-D、hs-CRP、ET-1低于轻、中、重度PH组(P<0.05),FIB低于中、重度PH组(P<0.05),但与轻度PH组的FIB水平相比,差异无统计学意义(P>0.05).轻、中、重度PH组D-D、FIB、hs-CRP、ET-1比较差异均有统计学意义(P<0.05).偏相关性分析,D-D、FIB、hs-CRP、ET-1与PH呈正相关关系(r=0.769、0.472、0.741、0.698,P<0.05).D-D与hs-CRP、ET-1呈正相关关系(r=0.779、0.734,P<0.05).Logistic回归分析显示,D-D、hs-CRP、ET-1是继发PH的独立危险因素,hs-CRP、ET-1是导致血液高凝状态的独立危险因素.结论AEPOCD患者存在血液高凝状态,D-D在继发PH发生、发展中起重要作用,其中继发PH及血液高凝状态均与hs-CRP、ET-1升高有关.

Objective To investigate the blood coagulation function and the correlation with pulmonary hypertension(PH)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods 168 patients with AECOPD were included into the AECOPD group.According to pulmonary artery systolic pressure(PASP),the patients were divided into non-PH group(≤30 mmHg,53 cases),mild PH group(31~50 mmHg,42 cases),moderate PH group(51~70 mmHg,38 cases)and severe PH group(≥71 mmHg,35 cases).50 healthy persons were selected as the control group.The activated partial thromboplas-tin time(APTT),prothrombin time(PT),D-dimer(D-D),fibrinogen(FIB),high-sensitivity C reactive protein(hs-CRP)and endothelin 1(ET-1)levels were detected.The correlation between blood coagulation factors,hs-CRP,ET-1 and secondary PH was analyzed by partial correlation analysis.The risk factors of secondary PH and hypercoagulability were analyzed by dual logistic regression analysis.Results There were no significant differences in the level of APTT and PT after treatment in AECO-PD group,compared with those in the same group before treatment and those in the control group(P>0.05).Levels of D-D,FIB,hs-CRP and ET-1 in AECOPD group were decreased.Compared with those before the treatment and those in the control group,there were significant differences(P<0.05).Levels of D-D,hs-CRP and ET-1 were lower in non-PH group than ate and severe PH group,respectively(P<0.05),while there was no significant difference compared with mild PH group(P>0.05).There were significant differences among mild,moderate and severe PH group in levels of D-D,FIB,hs-CRP and ET-1(P<0.05).Partial correlation analysis showed that the levels of D-D,FIB,hs-CRP and ET-1 were positively correlated with secondary PH(r=0.769,0.472,0.741,0.698,P<0.05).D-D was positively correlated with hs-CRP and ET-1(r=0.779,0.734,P<0.05).Logisitic regression analysis showed that D-D,hs-CRP and ET-1 were independent risk factors for secondary PH,while hs-CRP and ET-1 were independent risk factors for hypercoagulability.Conclusion The patients with AE-COPD exhibit hypercoagulability.D-D plays an important role in the occurrence and development of secondary PH.Secondary PH and hypercoagulability are related to the increase of hs-CRP and ET-1.