呼出气一氧化氮测定在AECOPD合并肺动脉高压患者中的临床意义

Clinical significance of exhaled nitric oxide measurement in patients with AECOPD and pulmonary hypertension

目的探讨呼出气一氧化氮(FeNO)在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压(PH)患者的应用,为指导临床提供参考依据。方法选取2018年7月—2020年7月呼吸内科住院的AECOPD合并PH患者52例作为研究组,根据PH严重程度分为轻、中、重三组;随机数字表法选取相同时间段诊断AECOPD而无PH患者52例,作为对照组。比较两组FeNO、动脉血气参数、外周血指标及探究AECOPD合并PH的影响因素。结果两组一般临床特征无统计学差异,研究组FeNO水平低于对照组(t=-1.751,P=0.083),但差异无统计学意义;研究组CaNO水平显著高于对照组(t=5.667,P<0.001),且重、中度组的CaNO水平均显著高于轻度组(P=0.003,P=0.027);研究组氧合指数(PaO_(2)/FiO_(2))低于对照组,动脉血二氧化碳分压高于对照组(P<0.05),经单因素和多因素Logistic回归分析,FeNO、CaNO、PaO_(2)/FiO_(2)、NLR、CRP水平是发生AECOPD合并PH的危险因素,随着患者CaNO水平的升高,FeNO、PaO_(2)/FiO_(2)水平降低,合并PH发病风险增加。结论通过检测AECOPD患者呼出气一氧化氮水平的变化,对预测是否合并PH及其严重程度有一定的临床意义。

Objective To explore the application of exhaled nitric oxide(FeNO)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and pulmonary hypertension(PH),in order to provide reference for clinical guidance.Methods 52 patients with AECOPD and pulmonary hypertension who were hospitalized in the Department of Respiratory Medicine from July 2018 to July 2020 were selected as the study group.According to the severity of PH,the patients were divided into three groups:the mild,moderate and severe groups.The random number table method selected the same period of time to diagnose AECOPD without PH.52 cases served as the control group.The levels of exhaled nitric oxide,arterial blood gas parameters,and peripheral blood indexes were compared between the two groups,and the influencing factors of AECOPD and PH were explored.Results The difference in general clinical characteristics between the two groups was not statistically significant.The FeNO level of the study group was lower than that of the control group(t=-1.751,P=0.083),but the difference was not statistically significant.The CaNO level of the study group was higher than that of the control group(t=5.667,P<0.001).The levels of CaNO in the severe and moderate groups were both significantly higher than that in the mild group(P=0.003,P=0.027).The oxygenation index(PaO_(2)/FiO_(2))in the study group was lower than that of the control group,and the partial pressure of arterial carbon dioxide was higher than that of the control group.Through univariate and multivariate logistic regression analysis,FeNO,CaNO,PaO_(2)/FiO_(2),NLR,and CRP levels were risk factors for AECOPD with PH.As the patient′s CaNO level increased,FeNO and PaO_(2)/FiO_(2) levels decreased,and the risk of PH increased.Conclusion By detecting changes in the level of nitric oxide in the exhaled breath of AECOPD patients,it has certain clinical significance in predicting whether it is associated with pulmonary hypertension and its degree.