呼出气一氧化氮在慢性阻塞性肺疾病急性加重期合并肺动脉高压患者中的初步探索

发布时间：2018-06-28 23:27

本文选题：慢性阻塞性肺疾病 + 慢性阻塞肺疾病急性加重期　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过观察慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压(PH)患者中呼出气一氧化氮(FeNO)的浓度变化,探讨其在AECOPD合并PH患者诊治中的临床意义。方法:选取2015年12月至2017年1月就诊于哈励逊国际和平医院呼吸内科的AECOPD患者,符合入选标准及排除标准的患者共119名,均签署知情同意书,记录其性别、年龄等一般情况。所有入选患者均于入院用药前检测其FeNO浓度。采用心脏超声检查检测其有无肺动脉高压,并估测其肺动脉压力(PASP)。记录相应数据,同时于患者住院过程中继续监测有无合并影响FeNO结果的其他疾病,对此类患者进行排除。经过逐一排查最终共有71名AECOPD患者纳入本研究,其中AECOPD组48例,AECOPD合并PH组23例。按估测的肺动脉压力将AECOPD合并PH组患者分为PH轻度、PH中度及PH重度组。记录同期两组患者各项检查结果包括血气分析、肺功能指标、C-反应蛋白(CRP)及脑钠肽(BNP)水平。于患者出院时记录其住院时间以及有无行有创机械通气治疗。用统计学方法比较两组患者FeNO水平,并进一步探查FeNO浓度与PH严重分度是否存在一定相关性。比较两组患者其它各项指标的差异,并探索FeNO水平与其它各项指标之间的关系。进一步探讨FeNO浓度变化在AECOPD合并PH患者中的应用。结果:1 AECOPD组患者与AECOPD合并PH患者在年龄、性别、血气分析、气道阻塞程度及有创机械通气率间的差异无统计学意义(P0.05)。但两组患者FeNO水平、CRP和BNP水平以及住院时间之间存在统计学差异,AECOPD合并PH患者FeNO水平更低,CRP及BNP水平更高,住院时间更长(P0.05)。2按估测的肺动脉压力对PH严重程度进行分度,PH轻度组FeNO水平高于PH中度及PH重度组,差异均有统计学意义(P0.05);但PH中度与PH重度组FeNO水平比较差异无统计学意义(P0.05)。3对FeNO与PH严重程度进行相关性分析发现FeNO水平与PH严重程度呈负相关(r=-0.616,P=0.002),PH越严重,FeNO水平越低。4通过ROC曲线发现,FeNO水平在诊断AECOPD患者是否合并肺动脉高压的截断值为24.5ppb,敏感度为66.7%,特异度为82.6%。5 FeNO水平与BNP、CRP存在一定的相关性,在不合并PH的AECOPD患者中,FeNO水平与CRP呈正相关(r=0.407,P=0.004),与BNP无显著相关;AECOPD患者合并PH时,FeNO水平和CRP呈负相关(r=-0.744,P0.001),与BNP也呈负相关(r=-0.619,P=0.002)。结论:1 AECOPD合并PH时,FeNO水平显著低于未合并PH的AECOPD患者,并且FeNO水平与PH严重程度呈负相关,PH严重程度越重,FeNO水平越低;2 FeNO对AECOPD是否合并肺动脉高压具有一定诊断价值;3 AECOPD不合并PH时,FeNO水平与CRP呈正相关,与BNP无显著相关;4 AECOPD患者合并PH时,FeNO水平和CRP及BNP均呈负相关。
[Abstract]:Objective: to observe the changes of exhalation nitric oxide (FeNO) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pulmonary hypertension (PH), and to explore its clinical significance in the diagnosis and treatment of AECOPD with PH. Methods: 119 patients with AECOPD from December 2015 to January 2017 in Department of Respiratory Medicine, Harrison International Peace Hospital, who met the criteria of inclusion and exclusion, all signed informed consent letters and recorded their gender, age and other general information. All patients were tested for FeNO concentration before admission. Pulmonary artery pressure (PASP) was evaluated by echocardiography. Record the corresponding data and continue to monitor if there are any other diseases that affect Feno outcome during hospitalization. A total of 71 AECOPD patients were included in this study, including 48 patients with AECOPD and 23 patients with PH. Patients with AECOPD complicated with PH were divided into moderate PH group and severe PH group according to the estimated pulmonary artery pressure. The results of blood gas analysis, lung function index, C-reactive protein (CRP) and brain natriuretic peptide (BNP) were recorded. The duration of hospitalization and the availability of invasive mechanical ventilation were recorded at the time of discharge. The levels of FeNO in the two groups were compared by statistical method, and the correlation between FeNO concentration and PH severity was further explored. To compare the difference of other indexes between the two groups and to explore the relationship between FeNO level and other indexes. To investigate the application of Feno concentration in patients with AECOPD complicated with PH. Results there was no significant difference in age, sex, blood gas analysis, airway obstruction degree and invasive mechanical ventilation rate between the two groups (P0.05). However, there were significant differences between the two groups in the levels of CRP and BNP and the length of stay. The levels of FeNO and BNP in patients with PH and AECOPD were lower, and the levels of CRP and BNP were higher than those in patients with PH. The duration of hospitalization was longer (P0.05) .2 FeNO level in mild PH group was higher than that in moderate and severe PH group. The difference was statistically significant (P0.05), but there was no significant difference in FeNO levels between moderate and severe PH groups (P0.05). 3. The correlation analysis between FeNO and PH severity showed that FeNO level was negatively correlated with PH severity (r 0. 616 P0. 002). The more severe PH was, the more serious FeNO level was. The lower the ROC curve was, the lower the ROC curve showed that the truncation value, sensitivity and specificity of Feno in diagnosis of pulmonary hypertension in AECOPD patients were 24.5 ppb, 66.7, and 82.6%, respectively, and there was a certain correlation between FeNO level and BNP-CRP. In AECOPD patients without PH, the level of FeNO was positively correlated with CRP (r = 0.407, P0. 004). There was no significant correlation between FeNO level and CRP in AECOPD patients with PH (r-0.744P0.001), and a negative correlation between FeNO level and BNP (r-0.619P0. 002). Conclusion the level of FeNO in patients with PH was significantly lower than that in patients without PH. There was a negative correlation between FeNO level and PH severity. The more severe PH was, the lower FeNO level was. FeNO had a certain diagnostic value for AECOPD complicated with pulmonary hypertension. There was a positive correlation between FeNO level and CRP when AECOPD was not associated with PH. There was no significant correlation with BNP. The level of FeNO in patients with PH was negatively correlated with CRP and BNP.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R544.1

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