稳定期慢性阻塞性肺疾病合并肺动脉高压危险因素的回顾性分析

Retrospective analysis of risk factors for stable chronic obstructive pulmonary disease combined with pulmonary hypertension

目的分析稳定期慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者的临床特征和危险因素。方法选择2020年1月—2022年1月在宁夏医科大学总医院就诊的199例稳定期COPD合并PH患者和150例单纯稳定期COPD患者(作为对照组),比较2组患者的临床资料,并分析稳定期COPD合并不同严重程度PH的临床特征和危险因素。结果(1)COPD组与COPD合并PH组患者多个临床相关指标结果差异均有统计学意义。进一步将COPD合并PH患者分为轻度、中度和重度PH组,3组间红细胞分布宽度(RDW)、N末端B型脑钠肽原(NT-proBNP)、PCO_(2)、HCO_(3)^(-)、每搏输出量(SV)和右室前后径(RVD)差异均有统计学意义(P<0.05)。(2)相关性分析显示,心脏指数(CI)、系统免疫炎症指数(SII)和SV与肺动脉压力呈负相关,而RVD、RDW、PCO_(2)、HCO_(3)^(-)、NT-proBNP与肺动脉压力均呈正相关关系。(3)多因素logistic回归分析结果显示,NT-proBNP值升高是稳定期COPD合并重度PH的独立危险因素(P<0.05)。(4)ROC曲线结果显示,NT-proBNP的AUC值为0.827,高于RDW和HCO_(3)^(-)的AUC值。结论NT-proBNP值升高是稳定期COPD合并重度PH的独立危险因素;CI、SII、RDW、PCO_(2)、HCO_(3)^(-)、NT-proBNP、SV和RVD与稳定期COPD合并PH具有相关性。

Objective To analyze the clinical characteristics and risk factors of patients with stable chronic obstructive pulmonary disease(COPD)combined with pulmonary hypertension(PH).Methods A total of 199 patients with stable COPD combined with PH and 150 patients with pure stable COPD were collected from January 2020 to January 2022 at General Hospital of Ningxia Medical University as the control group.The clinical data of the two groups were compared,and the clinical characteristics and risk factors of stable COPD combined with different severity of PH were analyzed.Results(1)There were significant differences in several clinical indicators between the COPD group and the COPD combined with PH group.Furthermore,the COPD combined with PH patients were further divided into mild,moderate,and severe PH groups,and there were significant differences in red cell volume distribution width(RDW),N-terminal pro-brain natriuretic peptide(NT-proBNP),PCO_(2),HCO_(3)^(-),stroke volume(SV),and right ventricular anterior-posterior diameter(RVD)among the three groups(P<0.05).(2)Correlation analysis showed that cardiac index(CI),systemic immune-inflammation index(SII),and SV were negatively correlated with pulmonary artery pressure,while RDW,PCO_(2),HCO_(3)^(-),and NT-proBNP were positively correlated with pulmonary artery pressure.(3)The results of multivariate logistic regression analysis showed that an elevated NT-proBNP level was an independent risk factor for severe PH in stable COPD(P<0.05).(4)The ROC curve results showed that the AUC value of NT-proBNP was 0.827,higher than the AUC values of RDW and HCO_(3)^(-).Conclusion An elevated NT-proBNP level is an independent risk factor for severe PH in stable COPD.In addition,there is a correlation between CI,SII,RDW,PCO_(2),HCO_(3)^(-),NT-proBNP,SV,and RVD in stable COPD combined with PH.