凝血相关指标对慢性阻塞性肺疾病急性加重期继发肺动脉高压的意义

The significance of blood coagulation related indicators in acute exacerbation of chronic obstructive pulmonary diseases complicated pulmonary hypertension secondary

目的探讨凝血相关指标对慢性阻塞性肺疾病急性加重期(AECOPD)继发肺动脉高压(PH)患者的意义。方法通过超声心动图测定124例AECOPD患者肺动脉收缩压(PASP),据此将患者分为正常组及轻度、中度、重度PH组,采取自动血凝仪测定凝血四项指标,经由免疫比浊法测定血清D-二聚体。以体检健康的人群作为对照组。结果 AECOPD患者活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体水平均长于或高于对照组(P<0.05);AECOPD合并不同程度PH患者凝血酶原时间(PT)、凝血酶时间(TT)、APTT比较,差异无统计学意义(P>0.05);中度、重度PH组患者FIB、D-二聚体水平均高于正常组和轻度PH组(P<0.05),病死率高于正常组(P<0.05)。结论 FIB、D-二聚体等凝血相关指标对AECOPD继发PH诊断有重要作用。

Objective To investigate the significance of coagulation related indicators in pulmonary hypertension(PH)secondary to acute exacerbation of chronic obstructive pulmonary disease(AECOPD).MethodsThe pulmonary artery systolic pressure(PASP)of 124 patients with AECOPD were measured by using echocardiography.According to the results,the patients were divided into the normal PH group,mild PH group,moderate PH group and severe PH group.The four indicators of blood coagulation were measured by the automatic coagulation analyzer,and serum D-dimer was determined by immune turbidimetry.Healthy individuals were enrolled in the study as the control group.Results The activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer concentrations in patients with AECOPD were significantly longer or higher than those in the control group(P<0.05).There were no significant differences in prothrombin time(PT),thrombin time(TT)and APTT among patients with AECOPD complicated with different degrees of PH(P>0.05).FIB and D-dimer concentrations in patients with moderate or severe PH were significantly higher than those in the normal PH group and mild PH group(P<0.05),and the mortality rate was significantly higher than that in the normal group(P<0.05).Conclusion Coagulation related indicators such as FIB and D-dimer play an important role in the diagnosis of PH secondary to AECOPD.