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目的研究吸烟、全身炎症反应与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中发生肺动脉高压(pulmonary hypertension,PH)之间的关系。方法连续收集我研究所2013年4月至2015年3月收治的111例COPD合并PH的住院患者作为病例组,匹配年龄、性别后以同期111例COPD未合并PH的住院患者作为对照组,记录患者年龄、性别、吸烟史等一般资料,采集患者入院24 h内血沉(erythrocyte sedimentation rate,ESR)、白细胞(white blood cell,WBC)、中性粒细胞/淋巴细胞比例(neutral granular cell/lymphocyte ratio,NLR)、血清C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、纤维蛋白原、降钙素原(procalcitonin,PCT)、动脉血气、胸部CT及心脏彩超等结果。结果 COPD合并PH组的吸烟指数、CRP、IL-6及TNF-α均明显高于COPD未合并PH组(P<0.01),且与肺动脉收缩压呈正相关(r=0.271、0.181、0.270、0.208,P<0.05),多因素Logistic回归分析结果显示吸烟、CRP、IL-6及TNF-α是PH形成的独立危险因素(OR=6.185、6.740、3.434、2.700,P<0.05)。结论吸烟及血清中CRP、IL-6及TNF-α升高与肺动脉压力升高呈正相关,提示吸烟、机体炎症反应与COPD发生PH密切相关。
Objective To investigate the relationship between smoking, systemic inflammatory response and pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 111 inpatients with COPD and PH admitted to our institute from April 2013 to March 2015 were enrolled in this study. 111 patients with COPD who did not receive PH during the same period were matched as the control group after matching age and sex. The patients’ age, sex, smoking history and other general information were collected. The erythrocyte sedimentation rate (ESR), white blood cell (WBC), neutral granular cell / lymphocyte ratio (NLR), serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), fibrinogen, procalcitonin , PCT), arterial blood gas, chest CT and cardiac ultrasonography and other results. Results The smoking index, CRP, IL-6 and TNF-α in COPD group were significantly higher than those in non-COPD group (P <0.01), and were positively correlated with pulmonary artery systolic pressure (r = 0.271,0.181,0.270,0.208 , P <0.05). Logistic regression analysis showed that smoking, CRP, IL-6 and TNF-α were independent risk factors for PH formation (OR = 6.185,6.740,3.434,2.700, P <0.05). Conclusions Smoking and the increase of CRP, IL-6 and TNF-α in serum and serum are positively correlated with the increase of pulmonary artery pressure, suggesting that smoking and the inflammatory reaction of body are closely related to the occurrence of COPD.