高原地区慢性阻塞性肺疾病继发性肺动脉高压的危险因素研究  

Risk factors of secondary pulmonary hypertension in chronic obstructive pulmonary disease in plateau area

作　　者：李国慧 和嘉明 许振玲 拉姆央宗 王江丽 张玉风 Li Guohui;Jia Ming;Xu Zhenling;Ram Yangzong;Wang Jiangli;Zhang Yufeng(Department of Respiratory and Critical Care Medicine,Diqing Tibetan Autonomous Prefecture People’s Hospital,Yunnan Diqing 674409,China;Diqing Tibetan Autonomous Prefecture People’s Hospital Office,Yunnan Diqing 674409,China;Department of Pharmacy,Diqing Tibetan Autonomous Prefecture People’s Hospital,Yunnan Diqing 674409,China)

机构地区：[1]迪庆藏族自治州人民医院呼吸与危重症医学科,云南迪庆674409 [2]迪庆藏族自治州人民医院院办公室,云南迪庆674409 [3]迪庆藏族自治州人民医院药学部,云南迪庆674409

出　　处：《中国医刊》2023年第1期46-49,共4页Chinese Journal of Medicine

基　　金：迪庆州创新团队培育计划(2020FA001)。

摘　　要：目的研究高原地区慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)继发性肺动脉高压的危险因素。方法回顾性分析2020年1月至2022年4月迪庆藏族自治州人民医院呼吸与危重症医学科就诊的180例COPD患者的临床资料。根据肺动脉收缩压(pulmonary arterial systolic pressure,PASP)进行分组,90例PASP≥40mmHg的患者作为肺动脉高压组,90例PASP<40mmHg的患者作为对照组。收集患者一般资料,包括性别、年龄、体重指数、病程、文化程度、主动吸烟、被动吸烟、生物燃料接触史等;检测患者肺功能[用力肺活量(forced vital capacity,FVC)、第1s用力呼气容积(1s forced expiratory volume,FEV_(1))、FEV_(1)/FVC];检测血氧饱和度(oxygen saturation,SpO2)、血小板计数、血小板分布宽度、平均血小板体积、血红蛋白、凝血酶原时间(prothrombin time,PT)、凝血酶原时间国际标准化比值(international normalized ratio of prothrombin time,PT-INR)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin time,TT)、D-二聚体等指标。以ROC曲线分析PT、APTT、FIB、D-二聚体对高原地区COPD患者继发性肺动脉高压的诊断价值,采取非条件logistic逐步回归分析高原地区COPD患者继发性肺动脉高压的危险因素。结果与对照组比较,肺动脉高压组FEV_(1)<50%的患者比例较高,并且PT、APTT较长,FIB、D-二聚体水平较高,差异有显著性(P<0.05)。经ROC分析,PT≥11.526s、APTT≥27.705s、FIB≥3.359g/L、D-二聚体≥1.218mg/L是高原地区COPD患者继发肺动脉高压的最佳截断值(P<0.05)。Logistic回归分析显示,PT、APTT、FIB、D-二聚体是高原地区COPD患者继发性肺动脉高压的危险因素(P<0.05)。结论高原地区COPD患者继发性肺动脉高压发生率较高,其中FEV_(1)、PT、APTT,FIB、D-二聚体可能是COPD患者发生肺动脉高压的危险因素。Objective To study the risk factors of pulmonary hypertension secondary to chronic obstructive pulmonary disease(COPD)in plateau area.Method Clinical data of 180 COPD patients admitted to Diqing Tibetan Autonomous Prefecture People’s Hospital from January 2020 to April 2022 were retrospectively analyzed.pulmonary arterial systolic pressure(PASP)was grouped.Patients with PASP≥40mmHg were classified as the pulmonary arterial hypertension group(90 cases)and those with PASP<40mmHg as the control group(90 cases).General data were collected,including gender,age,BMI,course of disease,education level,active smoking,passive smoking,biofuel exposure history,etc.Pulmonary function[forced vital capacity(FVC),forced expiratory volume in 1s(FEV1),FEV1/FVC]was detected.Blood oxygen saturation(SpO2),platelet count,platelet distribution width,mean platelet volume,hemoglobin,prothrombin time(PT),international standardized ratio of prothrombin time(PT-INR),activated partial thrombin time(APTT),fibrinogen(FIB),thrombin time(TT),D-dimer and other indicators were detected.ROC curve was used to analyze the diagnostic value of PT,APTT,FIB and D-dimer in COPD patients with secondary pulmonary hypertension in plateau area,and the risk factors of secondary pulmonary hypertension in COPD patients in plateau area were analyzed by conditional Logistic stepwise regression.Result Compared with the control group,the proportion of patients with FEV1<50%in pulmonary arterial hypertension group was higher,and the PT and APTT were longer,and the levels of FIB and D-dimer were higher,the difference was significant(P<0.05).According to ROC analysis,PT≥11.526s,APTT≥27.705s,FIB≥3.359g/L and D-dimer≥1.218mg/L were the best cut-off values for secondary pulmonary hypertension in COPD patients in plateau area,with P<0.05.Logistic regression analysis showed that PT,APTT,FIB and D-dimer were secondary risk factors of pulmonary hypertension in COPD patients in plateau area(P<0.05).Conclusion The incidence of secondary pulmonary hypertension is high

关 键 词：慢性阻塞性肺疾病 高原地区 继发性肺动脉高压 凝血指标 

分 类 号：R563.1[医药卫生—呼吸系统]