慢性阻塞性肺疾病相关肺动脉高压中肺动脉压力与肺功能的关联性研究  

Correlation between pulmonary artery pressure and pulmonary function in chronic obstructive pulmonary disease related pulmonary hypertension

作　　者：张炜[1] 丁朵 王蕾[2] ZHANG Wei;DING Duo;WANG Lei(Department of Emergency,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Pulmonary and Critical Care Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学第一附属医院急诊科,陕西西安710061 [2]西安交通大学第二附属医院呼吸与危重症医学科,陕西西安710004

出　　处：《西安交通大学学报（医学版）》2022年第6期889-894,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：中央高校基本科研业务费基金资助项目(No.xzy012020060);中国博士后基金资助项目(No.2021M702610);陕西省自然科学基金资助(No.2022JQ-940);国家自然科学基金资助项目(No.8227055)。

摘　　要：目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中合并肺动脉高压(pulmonary hypertension,PH)的疾病特点,并明确COPD患者中PH的严重程度与肺功能损伤严重程度的相关性。方法共收集行心动超声检测并估测肺动脉收缩压(systolic pulmonary artery pressure,sPAP)的COPD患者565例。根据sPAP是否>35 mmHg将患者分为非COPD-PH组(243例)及COPD-PH组(322例);根据sPAP水平,将COPD合并PH患者分为轻度组、中度组及重度组。将COPD患者气流受限程度分为GOLD 1~4级。分析患者的一般临床资料特点、不同严重程度COPD合并PH患者组间肺功能指标差异及肺动脉压力与肺功能指标间的相关性。结果与非COPD-PH组患者相比,COPD-PH组患者年龄大(P=0.001),脑钠肽(brain natriuretic peptide,BNP)(P<0.001)、D-二聚体(D-dimer)水平较高(P=0.020)及肺一氧化碳弥散量(diffusing capacity of the lung for carbon monoxide,DLco)占预计值%较低(P=0.001)。轻度PH、中度PH及重度PH患者组间的氧分压(P=0.017)及DLco占预计值%(P=0.004)存在差异,重度PH患者较轻-中度PH患者的氧分压更低,PH严重程度分级越高,患者的DLco占预计值%越低。而三组间各项肺通气功能指标间均无统计学差异。GOLD 1~4各组间的sPAP无统计学差异,且不同严重程度COPD患者中的PH严重程度分布亦无差异。sPAP与DLco占预计值呈负相关关系,与各项肺通气指标无相关性。结论高龄、BNP及D-dimer可作为监测COPD患者发生PH的重要预测指标,血流动力学受损程度与气流受限程度不匹配,但与弥散功能受损程度呈负相关。Objective To investigate the characteristics of chronic obstructive pulmonary disease related pulmonary hypertension(COPD-PH)patients and determine the correlation between pulmonary hypertension severity and impaired lung function severity.Methods A total of 565 patients with COPD who underwent echocardiography and estimated pulmonary artery pressure(sPAP)were recruited.According to whether sPAP was greater than 35 mmHg,the patients were divided into non-COPD-PH group(243 cases)and COPD-PH group(322 cases).According to the level of sPAP,COPD-PH patients were subdivided into mild group,moderate group,and severe group.The degree of airflow limitation in patients with COPD was divided into GOLD 1 to 4.We analyzed the general clinical data characteristics of the patients,pulmonary function indexes differences among patients with different severity of COPD-PH,and the correlation between pulmonary artery pressure and pulmonary function indexes.Results Compared with patients in the non-COPD-PH group,those in the COPD-PH group were older(P=0.001),had a higher brain natriuretic peptide(BNP)level(P<0.001)and D-dimer level(P=0.020),and a lower diffusing capacity of the lung for carbon monoxide(DLco)%predicted(P=0.001).There were significant differences in the artery partial pressure of oxygen(Pa O2)(P=0.017)and DLco%predicted(P=0.004)among patients with mild PH,moderate PH,and severe PH.Severe COPD-PH group had lower Pa O2 compared with mildmoderate COPD-PH group,and the higher the PH severity classification,the lower the patients’DLco%predicted.No significant differences were found in lung ventilation function indexes.There was no significant difference in s PAP among GOLD 1 to 4 groups,and distribution of PH severity and COPD airflow limitation severity was not matched.There was a significant negative correlation between s PAP and DLco%predicted,but no significant correlation between s PAP and lung ventilation indexes.Conclusion Advanced age,BNP and D-dimer can be used as important predictors for PH occurrence in COPD p

关 键 词：慢性阻塞性肺疾病(COPD) 肺动脉高压 肺功能 

分 类 号：R563.9[医药卫生—呼吸系统]