维族老年慢性阻塞性肺疾病患者合并肺动脉高压的临床研究

Clinical analysis on Uygur elderly patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

摘要:

目的 分析维族老年慢性阻塞性肺疾病（COPD）患者合并肺动脉高压（PH）的患病情况和临床特征。方法 2014年2月至2015年5月在新疆莎车县人民医院综合内科确诊的稳定期维族老年COPD患者218例，根据心脏彩色多普勒超声分为非PH组（96例）、可疑PH组（68例）和确定PH组（54例）。比较PH组与非PH组的年龄、性别、体质量指数、疾病病史、肺功能检查、血气分析、血红蛋白（HGB）和脑钠肽前体（pro-BNP）等的差异。结果 PH组比非PH组的慢性咳嗽咯痰病史更长久（P＜0.01），合并糖尿病的概率更高（P＜0.05），HGB和pro-BNP的水平也偏高（均P＜0.01）。PH组第一秒用力呼气容积占预计值的百分比（FEV1%pred）、一氧化碳弥散量占预计值的百分比（DLCO% pred）和动脉血氧分压（PaO2）的测定值也均比非PH组高（P＜0.01），其他肺功能指标差异无统计学意义（P＞0.05）。结论 如能及早重视患者上述临床特征，并给予规范治疗，或可延缓维族老年COPD患者合并PH的进程并改善预后。

Abstract:

Objective To analyze the clinical characteristics in the Uygur elderly patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH). Methods Two hundred and eighteen Uygur elderly patients with stable COPD admitted in the People’s Hospital of Yarkant County from February 2014 to May 2015 were enrolled in this study. According to the results of echocardiography, they were divided into 3 groups, that is, the patients complicated with no PH (n＝96), suspected PH (n＝68) and identified PH (n＝54). Age, sex, body mass index, medical history, lung function, blood gas analysis, and serum levels of hemoglobin (HGB) and pro-brain natriuretic peptide (pro-BNP) were compared between those with identified PH and with no PH. Results The complicated PH group had significantly longer history of chronic cough and phlegm (P＜0.01), obviously higher incidence of diabetes (P＜0.05), and remarkably higher serum levels of HGB and pro-BNP (both P＜0.01) when compared with those with no PH. They also had significantly higher values in forced expiratory volume in one second percentage of predicted value (FEV1%pred), diffusing capacity percent predicted (DLCO% pred), and arterial partial pressure of oxygen (PaO2; P＜0.01), but not in other indices of lung function(P＞0.05). Conclusion Attention should be paid to the above abnormal features and standard treatment given correspondingly, which might delay the progression and improve the prognosis in the Uygur elderly patients of COPD combined with PH.