高原地区COPD合并肺心病的风险因素及其与血清hs-CRP、NT-proBNP、TNF-α的关系  

The risk of pulmonary heart disease in COPD patients at high altitude and its relationship with serum hs-CRP,NT-probNP and TNF-α

作　　者：鲜海英 何清华[2] XIAN Hai-ying;HE Qing-hua(Department of Internal Medicine,Sichuan Electric Power Hospital,Chengdu 610000,Sichuan,China;Department of Endocrinology Sichuan Electric Power Hospital,Chengdu 610000,Sichuan,China)

机构地区：[1]四川电力医院内科,四川成都610000 [2]四川电力医院内分泌科,四川成都610000

出　　处：《川北医学院学报》2024年第1期63-66,83,共5页Journal of North Sichuan Medical College

基　　金：四川省国康集团项目(【2020】24号)。

摘　　要：目的:分析高原地区慢性阻塞性肺疾病(COPD)患者合并慢性肺源性心脏病(CPHD)的风险及其与血清高敏C反应蛋白(hs-CPR)、N末端B型脑钠尿肽(NT-proBNP)、肿瘤坏死因子α(TNF-α)的关系。方法:回顾性分析127例高原地区COPD患者的病历资料,根据是否合并CPHD分为CPHD组(n=37)和非CPHD组(n=90)。比较两组患者一般资料及血清hs-CRP、NT-proBNP、TNF-α水平,使用多因素Logistic回归分析评价上述三项血清指标是否为影响高原地区COPD患者合并CPHD的独立危险因素,绘制受试者工作特性曲线(ROC)评价上述三项血清指标单独及联合预测高原地区COPD患者合并CPHD的效能。结果:CPHD组MPV、hs-CRP、NT-proBNP、TNF-α均高于非CPHD组(P<0.05),FEV1%、LVEF均低于非CPHD组(P<0.05)。Logistic回归分析结果显示,MPV≥11.40 fL、FEV1%<55.80%、hs-CRP≥21.02 mg/L、NT-proBNP≥513.00 ng/mL、TNF-α≥173.17 ng/mL是高原地区COPD患者合并CPHD的独立危险因素(P<0.05)。ROC曲线分析结果显示,hs-CRP、NT-proBNP、TNF-α对高原地区COPD患者合并CPHD均有一定预测效能,曲线下面积(AUC)分别为0.734、0.817、0.703;三项血清指标联合预测高原地区COPD患者合并CPHD的AUC为0.921。结论:血清hs-CRP、NT-proBNP、TNF-α的异常高表达是高原地区COPD患者合并CPHD的重要影响因素,三者联合有望成为高原地区COPD患者合并CPHD的灵敏性预测指标。Objective:To analyze the risk of chronic obstructive pulmonary disease(CPHD)in patients with chronic pulmonary heart disease(COPD)in plateau area and its relationship with serum hypersensitive C reactive protein(hs-CPR),N-terminal B type brain natriuretic peptide(NT-proBNP),tumor necrosis factor-α(TNF-α).Methods:The medical records of 127 COPD patients in plateau areas were retrospectively analyzed and collected,the subjects were divided into CPHD group(n=37)and non-CPHD group(n=90)according to whether CPHD was combined or not.Baseline data and serum hs-CRP,NT-probNP and TNF-αlevels were collected and compared between the two groups.Multivariate Logistic regression analysis was used to evaluate whether the above three serum indicators were independent risk factors for COPD patients with CPHD in plateau areas.Receive operating characteristic(ROC)was drawn to evaluate the efficacy of the above three serum indicators alone and in combination in predicting CPHD in COPD patients in plateau areas.Results:MPV,hs-CRP,NT-probNP and TNF-αin CPHD group were higher than those in non-CPHD group(P<0.05),while FEV1%and LVEF were lower than those in non-CPHD group(P<0.05).Logistic regression analysis showed that,MPV≥11.40 fL,FEV1%<55.80%,HS-CRP≥21.02 mg/L,NT-probNP≥513.00 ng/mL,TNF-α≥173.17 Ng/mL was an independent risk factor for COPD patients complicated with CPHD in plateau area(P<0.05).ROC curve analysis results showed that hs-CRP,NT-probNP and TNF-αall had certain predictive efficacy for COPD patients with CPHD in plateau area,and the areas under the curve(AUC)were 0.734,0.817 and 0.703,respectively,the AUC predicted by the above three serum indicators combined with CPHD in COPD patients in plateau area was 0.921.Conclusion:The abnormal high expression of serum hS-CRP,NT-probNP and TNF-αis an important influencing factor in COPD patients with CPHD in plateau area,and the combination of the three is expected to become a sensitivity predictor of CPHD in COPD patients with CPHD in plateau area.

关 键 词：慢性阻塞性肺疾病 慢性肺源性心脏病 高原地区 高敏C反应蛋白 N末端B型脑钠尿肽 肿瘤坏死因子-α 

分 类 号：R563.9[医药卫生—呼吸系统] R541.5[医药卫生—内科学]