血小板活化水平与慢性阻塞性肺疾病急性发作相关肺动脉高压的临床研究

Clinical study on the relationship between platelet activation and pulmonary hypertension in AECOPD patients

目的探究血小板活化标志物在评估慢性阻塞性肺疾病急性发作(AECOPD)患者相关肺动脉高压(PH)病情方面的价值,探索其联合血液学指标评估AECOPD患者合并PH病情的临床应用潜力。方法回顾性筛选2019年1月至2020年12月在太仓市第一人民医院诊断为AECOPD的住院患者,记录患者临床资料及实验室检验结果。根据患者心动超声检查结果计算肺动脉收缩压(PASP),据此判断患者是否合并PH。收集患者入院24 h内血液标本进行流式分析,探索血小板活化指标及联合血液学标志物与AECOPD患者合并PH的相关性及对相关病情的评估价值。结果入组122例患者,分为单纯AECOPD组(n=45)及AECOPD合并PH组(n=77)。按照PASP将入组患者分为无PH组(n=45)、轻度PH组(n=42)、中重度PH组(n=35)。PH组患者患病时间(年:18.3±14.7 vs.11.9±11.4,P<0.05)、炎症指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)]及血小板活化参数CD62P+/CD61+血小板百分比(%:20.7±8.6 vs.7.9±2.8,P<0.01)和荧光强度(48.8±12.9 vs.38.7±10.6,P<0.01)均明显高于单纯AECOPD组患者。Logistic回归分析提示,高CRP、高IL-6浓度及高血小板活化百分比是AECOPD患者合并PH的独立危险因素,该模型拟合优度P=0.984,能正确分类90.2%的研究对象。联合IL-6、CRP及CD62P+/CD61+血小板百分比对AECOPD患者合并PH有一定辅助评估的临床应用价值(AUC=0.972)。血小板活化百分比、PASP与PH严重程度呈正相关(r=0.822,P<0.01)。结论血小板活化参数CD62+/CD61+血小板百分比对AECOPD患者合并PH的病情评估具有一定的临床应用价值及潜力。

Objective To study the value of platelet activation markers in evaluating the condition of pulmonary hypertension(PH)in the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in order to further explore the potential of platelet activation markers combined with hematological indexes in evaluating the condition of AECOPD patients with PH in clinical application.Methods The inpatients diagnosed with AECOPD in Taicang First People′s Hospital from January 2019 to December 2020 were screened,and the clinical data and laboratory test results of the enrolled patients were recorded.According to the results of echocardiography,the pulmonary artery systolic pressure(PASP)was calculated,and whether the patient was diagnosed with PH was judged according to PASP.At the same time,blood samples were collected within 24 hours for flow cytometry analysis.To explore the correlation of platelet activation indexes and hematological markers with PH in the patients with AECOPD and the its evaluation value for related diseases.Results A total of 122 patients were enrolled.According to the results of echocardiography,the patients were divided into simple AECOPD group(n=45)and AECOPD combined with PH group(n=77).According to PASP,the patients were divided into no-PH group(n=45),mild PH group(n=42),moderate and severe PH group(n=35).There were significantly higher in the parameters in PH group compared with the simple AECOPD group,including the duration of illness(year:18.3±14.7 vs.11.9±11.4,P<0.05),inflammatory indexes[C-reactive protein(CRP),interleukin-6(IL-6)]and platelet activation parameters CD62P+/CD61+platelet percentage(%:20.7±8.6 vs.7.9±2.8,P<0.01)and fluorescence intensity(48.8±12.9 vs.38.7±10.6,P<0.01).Logistic regression analysis showed that high CRP,high IL-6 concentration and high percentage of platelet activation were independent risk factors for PH in the patients with AECOPD.The goodness of fit for this model was P=0.984,which can correctly classify 90.2%of the research objects.The combination of IL-6,CRP and CD62P+/CD61+platelet percentage had a certain clinical value of auxiliary evaluation in AECOPD patients with PH(AUC=0.972).In addition,the percentage of platelet activation and PASP were positively correlated with PH severity(r=0.822,P<0.01).Conclusions The platelet activation parameter CD62P+/CD61+platelet percentage has a certain clinical value and potential for the evaluation of AECOPD patients with PH.