呼出气一氧化氮及同型半胱氨酸对慢性阻塞性肺疾病急性加重期并发肺动脉高压患者的临床诊断价值

Clinical value of fractional exhaled nitric oxide and homocysteine in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease patients with pulmonary hypertension

目的探讨在慢性阻塞性肺疾病急性加重期(AECOPD)并发肺动脉高压(PH)患者中呼出气一氧化氮(FeNO)与同型半胱氨酸(HCY)检测的临床诊断价值。方法选取2019年1月—2020年12月就诊于芜湖市第一人民医院的AECOPD患者,共89例。根据合并肺动脉收缩压(pulmonary artery systolic pressure,PASP)情况,将上述患者分为3组:A组35例,AECOPD合并PASP<30 mmHg;B组28例,AECOPD合并PASP=30 mmHg~49 mmHg;C组26例,AECOPD合并PASP>50 mmHg(1 mmHg=0.133 kPa)。收集各组的一般资料,检测FeNO、HCY、外周血嗜酸性粒细胞(EOS)及超声心动图评估PASP,并对结果行相关性分析。结果3组FeNO和HCY比较,差异有统计学意义(P<0.05)。Pearson相关分析显示,FeNO值与AECOPD患者的PASP及HCY均呈负相关(r=-0.504,P<0.01)(r=-0.476,P<0.01);HCY值与AECOPD患者的PASP值呈正相关(r=0.369,P<0.01)。联合检测FeNO和HCY对AECOPD的诊断效能(AUC=0.771,95%CI:0.665~0.878)高于单独检测FeNO(AUC=0.837,95%CI:0.749~0.925)和HCY(AUC=0.726,95%CI:0.588~0.863)。结论随着AECOPD患者PASP的升高,FeNO值减低,HCY升高,参与AECOPD患者PH的发生和发展。

Objective To investigate the clinical value of fractional exhaled nitric oxide(FeNO)and homocysteine(Hcy)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with pulmonary hypertension(PH).Methods A total of 89 AECOPD patients who were admitted to Wuhu First People's Hospital from January 2019 to December 2020 were enrolled.According to their PSAP conditions,the patients were divided into three groups:group A(AECOPD patients with PASP<30 mmHg,n=35);group B(AECOPD patients with PASP=30 mmHg-49 mmHg,n=28)and group C(AECOPD patients with PASP>50 mmHg,n=26).Their general information was collected,while FeNO,HCY,and peripheral blood eosinophil(EOS)counts were detected and echocardiography was conducted for correlation analysis.Results There were statistical differences in FeNO and HCY among the three groups(P<0.05).According to Pearson correlation analysis,FeNO was negatively correlated with PASP and HCY(r=-0.504,P<0.01)(r=-0.476,P<0.01),while HCY was positively correlated with PASP(r=0.369,P<0.01).The diagnostic efficiency of FeNO+HCY(AUC=0.771,95%CI:0.665-0.878)was higher than FeNO(AUC=0.837,95%CI:0.749-0.925)and HCY(AUC=0.726,95%CI:0.588-0.863).Conclusions With the increase of PASP in AECOPD patients,FeNO decreases and Hcy increases,which are involved in the pathogenesis of PH in AECOPD patients.