慢性阻塞性肺疾病肺动脉高压与气流受限的相关性研究

目的探讨慢性阻塞性肺疾病（COPD）相关性肺动脉高压的发生率、及其与气流受限的相关性。方法对82例稳定期的COPD患者及26例健康对照者进行静态肺功能、血气分析及超声心动图检测。COPD患者依据肺功能指标进一步分级;根据超声心动图检测的肺动脉收缩压（PSAP）值,将COPD患者分为COPD并肺动脉高压组（PASP≥40mmHg）和单纯COPD组（PASP〈40mmHg）。结果 COPD患者肺动脉高压的发生率为22%,进一步分层发现轻,中、重、极重度COPD患者肺动脉高压发生率分别为5%、27%、29%和54%（χ2=9.04,P〈0.05）,两两比较仅极重度COPD组与轻度COPD组肺动脉高压发生率有显著性差异,其他组间比较差异无统计学意义。COPD并肺动脉高压组及单纯COPD组第一秒用力呼气容积占预计值的百分比（FEV1占预计值%）、FEV11/用力肺活量（FVC）（FEV1/FVC）、动脉血氧分压（PaO）2均较健康对照组降低（P〈0.01）。COPD并肺动脉高压组与单纯COPD组比较FEV1占预计值%、FEV1/FVC、一氧化碳弥散量占预计值的百分比（DLCO占预计值%）、动脉血二氧化碳分压（PaCO）2差异均无统计学意义（P均〉0.05）;两组间PaO2比较差异有统计学意义（P〈0.01）。COPD并肺动脉高压组、单纯COPD组及健康对照组3组间年龄及性别相比差异均无统计学意义（P均〉0.05）。PASP与FEV1占预计值%、FEV1/FVC、DLCO占预计值%呈显著负相关（分别为：r=-0.42,r=-0.52,r=-0.38,均P〈0.01）,PASP与PaO2相关性更强（r=-0.61,P〈0.01）。结论随着COPD病情的加重,肺动脉高压的发生率随之增加。气流受限在肺动脉高压的形成中并非单一因素,部分COPD患者存在与气流受限＂不成比例＂的肺动脉高压。

Study of the relationship between chronic obstructive pulmonary disease with pulmonary hypertension and airflow limitation

Objective To investigate the correlation between chronic obstructive pulmonary disease（COPD） with pulmonary hypertension and airflowlimitation.Methods 82 patients with stable COPD and 26 healthy controls underwent lung function tests,blood gas analysis and echocardiography.According to echocardiography in detecting pulmonary artery systolic pressure（PASP） values,the COPD patients were divided into pulmonary hypertension group（PASP ≥40mmHg） and simple COPD（PASP 40mmHg） group.The correlation of PASP with lung function parameters was analyzed.Results COPD patients with pulmonary hypertension accounted for 22%,further stratified found that light,moderate and severe and very severe COPD patients with pulmonary hypertension rates were 5%,27%,29% and 54%（χ 2 = 9.04,P0.05）.Comparison of only very severe COPD group and the mild COPD group,the incidences of pulmonary hypertension were significantly different,other differences between the two groups had no statistical significance.The forced expiratory volume in one second in percentage of predicted（FEV1%）,FEV1/forced vital capacity（FVC）,and arterial partial pressure of oxygen（PaO）2 of both COPD patients with pulmonary hypertension group and simple COPD group were significantly lower than those in healthy control group（P0.01）.FEV1%,FEV1/FVC,carbon monoxide diffusing capacity in percentage of predicted（DLCO%） and arterial partial pressure of carbon dioxide（PaCO）2 of COPD with pulmonary hypertension group and simple COPD group were similar（P all 0.05）;but PaO2 differences between the two groups were statistically significant（P0.01）.PASP was negatively correlated with the lung function parameters,including FEV1%,FEV1/FVC and DLCO%（respectively：r =-0.42,r =-0.52,r =-0.38,all P0.01）.PASP and PaO2 had a strong correlation（r=-0.61,P 0.01）.Conclusion As the COPD disease progression,the incidence of pulmonary hypertension increases.Airflow limitation in the formation of pulmonary hypertension is not a single factor.In some COPD patients with airflowlimitation,there is＂disproportionate＂pulmonary hypertension.