COPD继发性肺动脉高压患者血清中几种生物学活性物质的变化

摘要

目的明确血浆中C反应蛋白、内皮素-1、白介素-6、脑尿钠肽的水平与慢性阻塞性肺病（COPD）及COPD继发性肺动脉高压发生的相关性。方法研究对象来源于西安交通大学医学院第二附属医院呼吸内科2011年2月~2013年2月收治的174例COPD急性加重期患者。以多普勒心脏超声估测肺动脉收缩压力，并将肺动脉压力升高者分为轻度、中度及重度。采用ELISA试剂盒检测各血清学指标的水平。结果各血清学指标在单纯COPD患者组较对照组明显升高（P<0.05），且在COPD合并肺动脉压力升高组患者均较单纯COPD患者组升高（P<0.05）。其水平的升高与COPD继发的肺动脉压力升高程度（限于轻、中度肺动脉压力升高）呈显著正相关性，而COPD继发重度肺动脉高压时，仅脑尿钠肽的水平会随着肺动脉压力升高而增加（P<0.05），其余指标并未进一步升高（P>0.05）。结论早期、动态、联合监测上述血清学指标变化，可及时预警和估测COPD患者肺动脉压力的升高及其程度，对于早期诊断、治疗COPD继发性肺动脉高压及判断COPD预后有着重要的临床意义。%Objective To examine the correlation of the changes in the serum markers (C-reactive protein, endothelin-1, interleukin-6, and brain natriuretic peptide) with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension secondary to COPD. Methods A total of 174 COPD patients with acute exacerbation, admitted between February 2011 and February, 2013, were enrolled in this study, with 43 volunteers with normal pulmonary functions as controls. Pulmonary arterial pressure was determined by Doppler echocardiograph, and the severities (mild, moderate and severe) of PH secondary to COPD was evaluated. The levels of serum markers were determined using ELISA kits. Results The levels of serum markers in patients with COPD was significantly elevated compared with those of the control subjects (P<0.05), and further increased in patients with pulmonary hypertension secondary to COPD (P<0.05). A positive correlation was found between these serum markers and pulmonary artery pressure in COPD patients with mild and moderate pulmonary hypertension. In patients with severe pulmonary hypertension, only the serum level of brain natriuretic peptide continued to increase with pulmonary artery pressure (P<0.05), and the other markers did not further increase. Conclusions Early and combined examination of these serum markers in patients with COPD can help to identify pulmonary hypertension in early stage and estimate the severity of pulmonary hypertension. Hemodynamic monitoring of the changes of these serum markers can be of important clinical value in the treatment of pulmonary hypertension secondary to COPD and in evaluation of the prognosis of COPD.