高原地区慢性阻塞性肺疾病患者肺动脉高压发生率及危险因素分析

摘要

目的 评价高原地区慢性阻塞性肺疾病(COPD)患者肺动脉高压(PH)的发生率及可能的潜在危险因素.方法 选取2014年9月至2017年3月在该院呼吸科住院的川西高原地区的COPD患者261例作为研究对象,根据慢性阻塞性肺疾病全球倡议(GOLD指南)分级:GOLD Ⅰ级92例,GOLD Ⅱ级116例,GOLD Ⅲ级39例,GOLD Ⅳ级14例.患者常规进行彩色多普勒超声心动图检查,肺动脉收缩压(PASP)≥40 mm Hg(1 mm Hg＝0.133 kPa)拟诊为PH.结果 PH发生率为29.88％.Ⅰ级PH发生率为19.57％,明显低于Ⅱ级的34.48％和Ⅲ～Ⅳ级的37.74％,差异均有统计学意义(P＜0.05).PASP与第1秒用力呼气容积占预计值的百分比(FEV1％)、血氧饱和度、B型钠尿肽、平均血小板体积(MPV)、左心室射血分数、左心房内径存在相关关系(r＝ －0.297 、－0.303 、0.255 、0.302 、－0.336 、0.394,P＜0.05).Logistic回归分析显示,FEV1％、MPV为PH的危险因素.结论 高原地区COPD患者中PH发生率较高,FEV1％较低、MPV较高的患者更易发生 PH.%Objective To evaluate the prevalence and potential risk factors of pulmonary hypertension(PH)in patients with chronic obstructive pulmonary disease(COPD)from plateau area.Methods A total of 261 cases of COPD patients from the western Sichuan plateau area who were received in the hospital from Sep-tember 2014 to March 2017 were selected as the research subjects.According to the global initiative of chronic obstructive pulmonary disease(GOLD Guide),92 cases were at GOLD Ⅰ grade,116 cases were at GOLD Ⅱgrade,39 cases were at GOLDⅢ grade,and 14 cases were at GOLDⅣ grade.Routine color Doppler echocardio-graphy was performed.Patients with pulmonary arterial systolic blood pressure(PASP)≥ 40 mm Hg(1 mm Hg＝0.133 kPa)were diagnosed as PH.Results The prevalence of PH was 29.88％.The prevalence of GOLDⅠ grade PH was 19.57％,which was significantly lower 34.48％of GOLDⅡ grade PH and 37.74％of GOLDⅢ － Ⅳ PH,and the differences were statistically significant(P＜0.05).PASP was related to the per-centage(FEV1％),blood oxygen saturation,B type natriuretic peptide,mean platelet volume(MPV),left ven-tricular ejection fraction,and left atrium diameter(r＝ －0.297,－0.303,0.255,0.302,－0.336,0.394,P＜0.05).Logistic regression analysis showed that FEV1％and MPV were risk factors for PH.Conclusion The prevalence of PH is relatively high in COPD patients from plateau area,and patients with lower FEV1％and higher MPV are more likely to have PH.