D-二聚体、NT-proBNP对慢性阻塞性肺疾病并肺动脉高压的诊断价值

目的 分析血浆D-二聚体(DD)及N端脑钠肽前体(NT-proBNP)对慢性阻塞性肺疾病(COPD)并肺动脉高压(PH)的诊断价值.方法 选择自2013年1月至2016年1月我院呼吸内科住院并确诊为COPD的500名患者,根据有无合并PH分为PH组(n=236)和非PH组(n=264),并对COPD并PH的相关危险因素进行多因素Logistic回归分析,利用ROC曲线分析相关指标的诊断价值.结果 ①单因素分析示,PH组和非PH组两组间DD(t=9.912,P<0.05)、NT-proBNP(t=5.592,P<0.05)、LDH(t=7.592,P<0.05)、HCO3-(t=6.471,P<0.05)、PO2(t=5.461,P<0.05)、PCO2(t=6.618,P<0.05)、年龄>65岁(χ2=10.307,P<0.05)、慢性心功能不全(χ2=8.307,P<0.05)差异有统计学意义;②多因素Logistic回归分析示,DD、NT-proBNP、HCO3-、慢性心功能不全是COPD并PH的独立危险因素(P<0.05);③ROC曲线示,DD曲线下面积为0.830,最佳阈值为2.18mg/L,灵敏度为0.816,特异性为0.712;NT-proBNP曲线下面积为0.794,最佳阈值为3225ng/L,灵敏度为0.820,特异性为0.782.结论 联合DD及NT-proBNP水平对COPD并PH具有较高的诊断价值.

The Diagnostic Value of DD,NT-proBNP to Chronic Obstructive Pulmonary Disease with Secondary Pulmonary Hypertension

Objective To investigate the diagnostic value of D-dimer(DD), NT-proBNP to Chronic obstructive pulmonary disease(COPD) with secondary pulmonary hypertension(PH).Methods 500 cases of COPD enrolled to the Respiratory department of our hospital from January 2013 to January 2016 were selected.Patients were divided into two groups: PH group(n=236) and non-PH group(n=264).A multi-factor Logistic regression was performed to analyze the risk factors associated with the incidence of COPD with secondary PH, and the diagnostic value was verified on the risk factors by Receiver operating characteristic(ROC) curve.Results ① Univariate analysis showed that when comparing two groups: DD(t=9.912,P<0.05), NT-proBNP(t=5.592,P<0.05), LDH(t=7.592,P<0.05), HCO3-(t=6.471,P<0.05), PO2(t=5.461,P<0.05), PCO2(t=6.618,P<0.05), age>65 years(χ2=10.307, P<0.05), chronic heart failure(χ2=8.307, P<0.05).②Multi-factor Logistic regression indicated that DD, NT-proBNP, HCO3-, chronic heart failure were the independent risk factors for the onset of PH (P<0.05).③ROC curve analysis revealed that the optimal cutoff of DD to diagnose COPD with PH is 2.18mg/L(AUC=0.830, sensitivity 0.816,specificity 0.712), and the optimal cutoff of NT-proBNP to predict that is 3225ng/L(AUC=0.794, sensitivity 0.820, specificity 0.782).Conclusion The therapy of DD combined with NT-proBNP have a higher diagnostic value in chronic obstructive pulmonary disease with secondary pulmonary hypertension.