左心室收缩功能不全对慢性阻塞性肺疾病住院患者死亡的临床预测价值  

Clinical predictive value of left ventricular systolic dysfunction in mortality of hospitalized COPD patients

作　　者：张兵华 郭玮 李永鹏 王宏坤 郭永博 ZHANG Bing-hua;Guo Wei;LI Yong-peng;WANG Hong-kun;GUO Yong-bo(Department of Respiratory Medicine,986 Hospital of Air Force,Xi'an,Shaanxi 710054,China)

机构地区：[1]空军第986医院呼吸科

出　　处：《临床肺科杂志》2020年第3期329-331,346,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨左心室收缩功能对慢性阻塞性肺病(慢阻肺)急性加重期患者住院死亡率的影响。方法收集169例重度慢阻肺急性加重期患者的临床资料,包括白细胞、血气分析、C反应蛋白、N端脑钠肽前体及心脏彩超等,依据射血分数(ejection fraction,EF)将其分为两组:左室收缩功能正常组(EF%≥50%)及左室收缩功能障碍组(EF%<50%),进而比较两组患者死亡率及炎症因子等的差异。结果所有重度慢阻肺急性加重期住院患者中,35名(20.71%)EF%<50%,6例患者死亡,病死率为17.41%,134名患者(79.29%)EF%≥50%,6例患者死亡,病死率为4.45%。左室收缩功能正常组与障碍组之间在C反应蛋白、N端脑钠肽前体、动脉血乳酸水平及死亡率方面有显著差异(P<0.01)。EF与C反应蛋白呈负相关(r=-0.31,P<0.01)。Logistic多因素分析显示,EF<50%是重度COPD急性加重期患者死亡的独立危险因素(OR 2.38,95%CI 1.32~7.73)。结论重度慢阻肺急性加重住院患者中20.71%伴有左室收缩功能障碍,EF<50%是其死亡的独立危险因素。Objective To evaluate the predictive value of left ventricular systolic dysfunction to the mortality in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods The clinical data of 169 patients with acute exacerbation of chronic obstructive pulmonary disease were collected,including white blood cell,blood gas analysis,C-reactive protein,N-terminal pro brain natriuretic peptide,and echocardiography.Based on left ventricular ejection fraction(LVEF),all patients were classified into two groups:the COPD patients with normal LVEF group(EF≥50%)and the COPD patients with left ventricular systolic dysfunction group(EF<50%).Results There were 35 subjects(20.71%)with left ventricular systolic dysfunction,whose hospital mortality was 17.41%(6/35).Patients with left ventricular systolic dysfunction had higher levels of C-reactive protein,N-terminal pro-brain natriuretic peptide,lactic acid and hospital mortality(P<0.01).There was a negative correlation between EF and CRP(r=-0.31,P<0.01).Left ventricular systolic dysfunction(EF<50%)was significant predictor of hospital mortality(OR 2.38,95%CI 1.32~7.73),which was reflected by Logistic multivariate analysis.Conclusion 20.71%of patients with severe AECOPD present with left ventricular systolic dysfunction,which may be associated with mortality.

关 键 词：慢性阻塞性肺疾病 射血分数 住院死亡率 

分 类 号：R563.9[医药卫生—呼吸系统]