COPD患者血脂比值和氧化应激状态及其与#br# 肺动脉高压及预后的关系

目的：探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)患者血脂比值和氧化应激状态与其肺动脉高压及预后的关系。方法：随机选取河北省人民医院COPD患者120例为COPD组，另选取30例同期体检健康者为对照组。检测对照组和COPD组急性加重期和稳定期的低密度脂蛋白(LDL)/高密度脂蛋白(HDL)、三酰甘油(TG)/HDL、总胆固醇(TC)/HDL等血脂比值和血清超氧化物歧化酶(SOD)、丙二醛(MDA)和总抗氧化能力(total antioxidative capability，T-AOC)等氧化应激指标水平，统计其肺动脉高压的发生率和3年生存率并采用Spearman秩相关法分析其血脂比值和氧化应激状态与其肺动脉高压的发生率和3年生存率的关系。结果：与对照组比较，COPD组急性加重期和稳定期的LDL/HDL，TG/HDL，TC/HDL等血脂比值和血清MDA水平均升高，血清SOD和T-AOC水平则降低；与稳定期比较，COPD组急性加重期的血脂比值和血清MDA水平均升高，血清SOD和T-AOC水平则降低(P<0.05)。COPD组随访3年间肺动脉高压的发生率和3年生存率分别为56.67%和81.67%，且出现肺动脉高压和死亡的COPD患者的急性加重期和缓解期的血脂比值和血清MDA水平均高于无肺动脉高压和存活患者，血清SOD和T-AOC水平则低于无肺动脉高压和存活患者(P<0.05)。Spearman秩相关法分析结果显示，COPD患者LDL/HDL，TG/HDL，TC/ HDL等血脂比值和血清MDA水平与其3年间肺动脉高压的发生率均呈正相关(r=0.752，0.748，0.773，0.734；P<0.05)，与其3年生存率则呈负相关(r=–0.722，–0.751，–0.736，–0.748；P<0.05)；COPD患者血清SOD和T-AOC水平与其3年间肺动脉高压的发生率均呈负相关(r=–0.711，–0.734；P<0.05)，与其3年生存率则呈正相关(r=0.726，0.733；P<0.05)。结论：COPD患者血脂比值和氧化应激水平均较高，抗氧化能力则降低，且其血脂比值和氧化应激状态与其肺动脉高压及预后均相关，这可能和血脂与动脉硬化及营养状态相关和氧化应激影响COPD患者血管内皮功能等相关，因此COPD患者血脂比值和氧化应激状态可能用于其肺动脉高压及预后的评估。

Correlations between lipid ratio/oxidative stress status in COPD patients and pulmonary hypertension #br# as well as prognosis

Objective: To investigate the correlations between lipid ratio/oxidative stress status in chronic obstructive pulmonary disease (COPD) patients and pulmonary hypertension as well as the prognosis. Methods: A total of 120 patients with COPD were randomly selected and served as the COPD group and 30 healthy persons were selected as the control group. The ratios of low density lipoprotein (LDL)/high-density lipoprotein (HDL), triglyceride (TG)/HDL and total cholesterol (TC)/HDL were measured. The superoxide dismutase (SOD) activity, malondialdehyde (MDA) content and total antioxidant capacity (T-AOC) level in the control group and COPD patients were detected. Pulmonary hypertension incidence and 3-year survival rate for COPD patients were statistically analyzed. Spearman rank correlation method was used to analyze relationship between lipid ratio /oxidative stress status and pulmonary hypertension. Results: Compared with control group, the ratios of LDL/HDL, TG/HDL and TC/HDL, and the serum MDA level in the COPD group were increased, while the serum SOD and T-AOC level in the COPD group were decreased; compared with stable period, lipid ratios and MDA levels in the acute period were elevated, while serum SOD and T-AOC levels were reduced (P<0.05). Pulmonary hypertension incidence and 3-year survival rates in the COPD group were 56.67% and 81.67% respectively; the lipid ratios and serum MDA levels in COPD patients with pulmonary hypertension were elevated compared with that in COPD patients without pulmonary hypertension; the serum SOD and T-AOC levels in COPD patients with pulmonary hypertension were reduced compared with that in patients without pulmonary hypertension (P<0.05). Spearman rank correlation analysis showed that ratios of LDL/HDL, TG/HDL and TC/HDL, and the serum MDA levels in COPD patients were positively correlated with 3-years pulmonary hypertension incidence (r=0.752, 0.748, 0.752, 0.748; P<0.05), and negatively correlated with 3-years survival rate (r=–0.722, –0.751, –0.736, –0.748; P<0.05); serum SOD and T-AOC levels in COPD patients were negatively correlated with 3-years pulmonary hypertension (r=–0.711, –0.734; P<0.05), and positively correlated with 3-year survival rate (r=0.726, 0.733; P<0.05). Conclusion: Blood lipid ratio and oxidative stress levels in COPD patients are elevated while antioxidant abilities were attenuated. The lipid ratio and oxidative stress status in COPD patients is closely related to the prognosis of pulmonary hypertension. Therefore, blood lipid ratio and oxidative stress status may be used in evaluation of pulmonary hypertension and prognosis for COPD patients.