COPD患者肺动脉高压与急性加重的相关研究  

Importance of pulmonary hypertension in chronic obstructive pulmonary disease

作　　者：高平[1] 许菡苡[1] 劳妙婵[1] Gao Ping Xu Hanyi Lao Miaochan(Department of Respiratory Medicine, Ouangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China)

机构地区：[1]广东省人民医院呼吸科广东省医学科学院,广州510080

出　　处：《国际呼吸杂志》2017年第19期1468-1471,共4页International Journal of Respiration

摘　　要：目的探讨cOPD患者肺动脉高压对急性加重的预测作用。方法收集2013至2015年因COPD急性加重人院的76例患者资料，随访8个月，记录心脏彩超所测收缩期肺动脉压（systolic pulmonary artery pressure，sPAP）、急性加重次数。结果肺动脉压正常组和轻度肺动脉高压组间急性加重次数差异无统计学意义；中度、重度肺动脉高压组的急性加重次数均多于肺动脉压正常组、轻度肺动脉高压组，中度肺动脉高压组与重度肺动脉高压组的急性加重次数差异无统计学意义。肺动脉压力和有无急性加重发生的R0c曲线下面积AUC=0．786（95％CI：0．684～O．887），P=0．000，最佳界值点为sPAP=50mmHg，敏感度64％，特异度88．5％，阳性预测值91．2％，阴性预测值56．97％。结论因COPD急性加重而住院的患者sPAP〉50mmHg可作为再次急性加重的预测因子，中重度肺动脉高压的COPD患者可发生更频繁的急性加重。Objective To investigate the clinical relationship between the pulmonary hypertension and exacerbations of chronic obstructive pulmonary disease （COPD）. Methods Seventy-six patients hospitalized for COPD exacerbations were examed with transthoracic echocardiography （echo） in the study. We recorded data about systolic pulmonary artery pressure （sPAP） and the number of exacerbations within 8 months follow-up. Results There is no significant difference about exacerbations between patients with no pulmonary hypertension and mild pulmonary hypertension. The exacerbations of patients with moderate pulmonary hypertension were higher than that of patients with no pulmonary hypertension and patients mild moderate pulmonary hypertension. The exacerbations of patients with severe pulmonary hypertension were higher than that of patients with no pulmonary hypertension and patients with mild pulmonary hypertension. There is no significant difference about exacerbations between patients with moderate and severe pulmonary hypertension. ROC analysis showed that the sPAP cut-off value of 50 mmHg predicted patients who would have had exacerbations with 64% sensitivity and 88.5% speciticity, 91.2% positive predictive value, 56.97 % negative predictive value （ AUC = 0.786,95 % CI ： 0.684-0.887, P = 0.000）. Conehlsions SPAP 〉 50 mmHg could be the predictive factor for exacerbations. Patients with moderate or severe pulmonary hypertension might go through much more exacerbations.

关 键 词：肺动脉高压 慢性阻塞性肺疾病急性加重 心脏彩超 

分 类 号：R563.9[医药卫生—呼吸系统]