慢性阻塞性肺疾病患者患肺动脉高压的风险评估分析  

Risk assessment for pulmonary hypertension in patients with COPD

作　　者：朱国辉[1] 李庆云[1] 冯聪锐[1] 

机构地区：[1]广州市第一人民医院老年病科,广东广州510180

出　　处：《中国现代医学杂志》2012年第23期84-87,共4页China Journal of Modern Medicine

摘　　要：目的寻找慢性阻塞性肺疾病(COPD)患者患肺动脉高压(PH)的危险因素,并试图找到各因素具有临床意义的临界值,以利于PH的筛查。方法选择符合条件的145例门诊COPD患者,均予完成肺功能检查、6 min步行距离检查、圣乔治呼吸问卷及二维超声心电图检测。设定当收缩期肺动脉血压(sPAP)>35 mmHg时认为肺动脉高压,经单因素分析、χ2趋势测试及多因素Logistic回归检验,寻找与pH相关的危险因素。结果145例中只有113例患者符合分析条件,分析显示,6MWD和sPAP之间存在负相关(r=-0.27,P=0.005),单因素分析,支气管扩张剂给予前后FEV1(P=0.05和P=0.04)、运动血氧饱和度(P=0.004)和6MWD(P=0.005)与肺动脉高压显著相关。多因素分析中,仅仅运动血氧饱和度>3%和给药前FEV1仍然与肺动脉高压有显著性相关。经χ2趋势测试及多因素Logistic回归分析结果显示,年龄>55岁,运动血氧饱和度>3%,支气管扩张剂给予前FEV1<预测值的50%,6 min步行距离<358 m时患肺动脉高压的风险增加。结论通过对年龄、运动血氧饱和度、支气管扩张剂给予前FEV1、6 min步行距离数据分析,可大致评估COPD患者患肺动脉高压(PH)的风险。【Objective】 To develop a clinical tool to identify patients who should be sent for initial screening with echocardiography.【Methods】 Of 145 outpatient with COPD were screened.All underwent full pulmonary function testing,6-minute walk distance（6MWD）,exercise oximetry,Saint George＇s Respiratory Questionnaire,and transthoracic echocardiography.Elevated PAP was defined as a systolic PAP35 mmHg.Univariate associations were determined using analysis of variance（ANOVA） for continuous variables and v2 crosstabs for categorical data.Variables that were associated with elevated PAP at P ≤0.20 were retained for multivariate analysis.【Results】 113 outpatients with COPD were enrolled.There was a negative association between 6MWD and sPAP（r =-0.27,P =0.005）.Pre-and post-bronchodilator FEV1（P =0.05 and P =0.04,respectively）,exercise oxyhemoglobin desaturation（P =0.004）,and 6MWD（P =0.005） were associated with elevated PAP on univariate analysis.In multivariate analysis,statistically significant independent variables were3% decrease in exercise oxyhemoglobin saturation and decline in prebronchodilator FEV1.All parameters were considered in a composite risk model for elevated PAP in COPD.Those variables best suited for the model included age55 years,exercise oxyhemoglobin desaturation3,prebronchodilator FEV150% predicted,and 6MWD358 m.【Conclusion】 Age,exercise oxyhemoglobin desaturation,prebronchodilator FEV1,6MWD can be used to identify whether COPD patients is at high risk for elevated PAP.

关 键 词：慢性阻塞性肺疾病 肺动脉高压 右心导管介入术 超声心电图 风险评估 

分 类 号：R563[医药卫生—呼吸系统]