慢性阻塞性肺疾病急性加重期患者凝血功能障碍与炎症和高碳酸血症的相关性分析  

Correlation analysis of coagulation dysfunction,inflammation,and hypercapnia in patients with acute exacerbation of COPD

作　　者：周香 郑兰兰 ZHOU Xiang;ZHENG Lanlan(Department of Respiratory Medicine,the Eighth People′s Hospital of Hefei,Hefei,Anhui 238008,China)

机构地区：[1]合肥市第八人民医院呼吸内科,安徽合肥238008

出　　处：《临床肺科杂志》2025年第4期587-591,596,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者凝血功能障碍与炎症和高碳酸血症的相关性。方法选取2022年1月至2024年1月收治的AECOPD患者205例,伴有高碳酸血症者32例纳入观察组,非高碳酸血症者173例纳入对照组。比较两组人口学及临床资料、凝血指标和炎症标志物,分析炎症标志物、凝血指标和血气分析指标的相关性,以及对高碳酸血症的影响和分类价值。结果观察组过去1年急性加重、吸烟、合并肺炎和肺心病比例高于对照组。降钙素原(PCT)、C-反应蛋白(CRP)、凝血酶原时间(PT)、D-二聚体、纤维蛋白原(FIB)和国际标准化比值(INR)与pH值和氧分压(PaO 2)呈负相关,与二氧化碳分压(PaCO 2)呈正相关,PT、D-二聚体和FIB与PCT和CRP呈正相关。CRP、FIB和PT是AECOPD患者高碳酸血症的独立影响因素。CRP、FIB和PT的AUC分别为0.652、0.624和0.666,CRP+FIB+PT的AUC为0.978(0.933~0.996),敏感度为98.18%,特异度为90.77%,高于单独或两指标联合。结论慢阻肺急性加重期患者凝血功能障碍和炎症与高碳酸血症有关,此类患者入院期间应注意CRP、FIB和PT变化,及时进行抗炎治疗并预防血栓形成。Objective To analyze the correlation of coagulation dysfunction and inflammation with hypercapnia in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 205 AECOPD patients admitted from January 2022 to January 2024 were selected.32 patients with hypercapnia were included in the observation group,and 173 patients without hypercapnia were included in the control group.Their demographic and clinical data,coagulation indicators,and inflammatory markers were compared,and the correlation between inflammatory markers,coagulation indicators,and blood gas analysis indicators was analyzed,as well as their impact and classification value on hypercapnia.Results The proportion of acute exacerbation,smoking,combined pneumonia,and pulmonary heart disease in the observation group was higher than that in the control group in the past year.Procalcitonin(PCT),C-reactive protein(CRP),prothrombin time(PT),D-dimer,fibrinogen(FIB),and international normalized ratio(INR)were negatively correlated with pH and partial pressure of oxygen(PaO 2),and positively correlated with partial pressure of carbon dioxide(PaCO 2).PT,D-dimer,and FIB were positively correlated with PCT and CRP.CRP,FIB,and PT were independent influencing factors of hypercapnia in AECOPD patients.The AUC of CRP,FIB,and PT were 0.652,0.624,and 0.666,respectively.The AUC of CRP+FIB+PT was 0.978(0.933–0.996),with a sensitivity of 98.18%and a specificity of 90.77%,which was higher than those of the two indicators alone or in combination.Conclusion Coagulation dysfunction and inflammation in patients with acute exacerbation of COPD are related to hypercapnia.Those patients with this condition should pay attention to changes in CRP,FIB,and PT during hospitalization,and receive timely anti-inflammatory treatment to prevent thrombosis.

关 键 词：慢性阻塞性肺疾病急性加重 凝血功能 炎症 血栓形成 高碳酸血症 

分 类 号：R563.9[医药卫生—呼吸系统]