高龄慢性阻塞性肺疾病患者心电图特征与肺功能及实验室指标的相关性

A study on correlation between electrocardiogram characteristics and lung function and laboratory indexes in elderly patients with chronic obstructive pulmonary disease

目的分析高龄慢性阻塞性肺疾病(COPD)患者心电图特征与肺功能及实验室指标值的相关性。方法回顾性分析2018年10月-2023年10月西部战区总医院收治的120例高龄COPD患者的临床资料,根据COPD分期分为稳定期组(n=72)和急性加重期组(n=48)。观察并比较2组的基线资料、临床体征、肺功能指标值、实验室指标值及心电图特征检测值,分析心电图特征检测值与肺功能指标值及实验指标值之间的相关性。结果120例高龄COPD患者中,稳定期72例(稳定期组),出现急性加重期48例(急性加重期组)。稳定期组年龄显著低于急性加重期组(P<0.05),2组性别、BMI、饮酒、吸烟等基线资料差异无统计学意义(P<0.05);稳定期组肺部感染发生率及肺部CT(肺气肿、肺大疱)临床体征观察值显著低于急性加重期组(P<0.05),2组首发症状、肺部体征观察值差异均无统计学意义(P>0.05);稳定期组FeNO水平显著低于急性加重期组(P<0.05),FVC、FEV1值显著高于急性加重期组(P<0.05);稳定期组WBC、CRP、PaCO_(2)、IL-6、IgE和TNF-a水平显著低于急性加重期组(P<0.05),2组PaO_(2)水平和pH值差异均无统计学意义(P>0.05);稳定期组P波电轴、P波时间、QRS波电轴及I导联QRS波的振幅显著低/少于急性加重期组(P<0.05),其他指标值差异均无统计学意义(P>0.05);患者P波电轴、P波时间、QRS波电轴及I导联QRS波的振幅与FeNO、CRP、PaCO_(2)、IL-6、IgE和TNF-a水平存在相关性;FVC、FEV1、WBC值与P波电轴、P波时间不相关,但与QRS波电轴及I导联QRS波的振幅存在相关性。结论高龄急性加重期患者的临床表现和心电图改变与稳定期COPD具有差异,应关注患者年龄、肺功能、相关实验室指标及心电图情况,以有效控制COPD的进展。

Objective To analyze the correlation between electrocardiogram(ECG)characteristics and lung function and laboratory indexes in elderly patients with chronic obstructive pulmonary disease(COPD).Methods The clinical data of 120 elderly COPD patients admitted to General Hospital of Western Theater Command from October 2018 to October 2023 were retrospectively analyzed.According to the COPD stage,they were divided into stable group(n=72)and acute exacerbation group(n=48).Baseline data,clinical signs,pulmonary function indexes,laboratory indexes and ECG characteristics of the two groups were observed and compared.The correlation between ECG characteristic detection value and lung function indexes and experimental indexes was analyzed.Results Among 120 elderly COPD patients,there were 72 cases in the stable stage(stable stage group)and 48 ones in the acute exacerbation stage(acute exacerbation group).The age of the stable stage group was significantly younger than that of the acute exacerbation phase group(P<0.05),but there was no statistically significant difference in baseline data such as gender,BMI,alcohol consumption,and smoking between the two groups(P<0.05).The incidence of pulmonary infection and clinical signs observed on pulmonary CT(emphysema and bullosa)in the stable stage group were significantly lower than those in the acute exacerbation stage group(P<0.05).There were no significant differences in the first symptoms and pulmonary signs between the two groups(P>0.05).FeNO level of the stable stage group was significantly lower than that of the acute exacerbation group(P<0.05),while FVC and FEV1 values were significantly higher than those of the acute exacerbation group(P<0.05).The levels of WBC,CRP,PaCO_(2),IL-6,IgE and TNF-a of the stable stage group were significantly lower than those of the acute exacerbation stage group(P<0.05),but there was no statistical significance in PaO 2 level and pH value between the two groups(P>0.05).The P wave axis,P wave time,QRS wave axis and I-lead QRS wave amplitudes of the stable stage group were significantly lower/shorter than those of the acute exacerbation stage group(P<0.05),but there were no significant differences in other index values(P>0.05).P wave axis,P wave time,QRS wave axis and I-lead QRS amplitude were correlated with the levels of FeNO,CRP,PaCO_(2),IL-6,IgE and TNF-a.FVC,FEV1 and WBC were not correlated with the P wave axis and P wave time,but were correlated with the QRS wave axis and the I-lead QRS wave amplitude.Conclusion The clinical manifestations and ECG changes in elderly patients with acute exacerbation are different from those in elderly patients with stable COPD.Attention should be paid to age,lung function,relevant laboratory indexes,and ECG of patients to effectively control the progression of COPD.