PASP及RVAW联合血清肌酐在COPD-PH预后中的价值

摘要/Abstract

摘要： 目的评估PASP及RVAW联合血肌酐在慢性阻塞性肺疾病相关肺动脉高压（COPD-PH）预后中的价值。方法回顾性分析2021年1月—6月宁夏回族自治区人民医院收治的COPD-PH患者,出院后1年对其进行随访,依据生存状态分为死亡组和存活组,比较两组患者的一般情况、实验室指标、超声心动图参数等临床资料。以COPD-PH是否发生死亡为因变量,以身体质量指数、肺动脉收缩压（PASP）、右室前壁厚度（RVAW）、右室前后径（RV-ap）、红细胞分布宽度-标准差（RDW-SD）,白清白蛋白（ALB）、肌酐（Scr）、尿素氮（BUN）、纤维蛋白原降解产物为自变量,采用Logistic回归分析COPD-PH死亡的危险因素。利用ROC曲线评估各危险因素单独及联合预测COPD-PH死亡的效果。结果本研究共纳入85例患者,死亡组26例（30.59%）,存活组59例（69.41%）。与存活组比较,死亡组患者的PASP[65.00 mm Hg（48.25 mm Hg,85.25 mm Hg）vs. 40.20 mm Hg（36.95 mm Hg,53.33 mm Hg）],RVAW[4.10 mm（3.80 mm,6.70 mm）vs. 3.80 mm（3.60 mm,4.00 mm）],Scr[76.50 μmmol/L（65.25 μmmol/L,93.25 μmmol/L）vs.66.00 μmmol/L（56.00 μmmol/L,72.00 μmmol/L）]较高,差异有统计学意义（P<0.05）。Logistic回归分析显示PASP升高（OR=1.055,95%CI 1.011~1.100,P=0.013）、右室前壁增厚（OR=2.321,95%CI 1.138~4.732,P=0.021）、肌酐升高（OR=1.051, 95%CI 1.017~1.086, P=0.003）是COPD-PH死亡的独立危险因素。受试者操作特征（ROC）曲线分析提示PASP+RVAW+Scr联合预测的COPD-PH死亡的价值最优,ROC曲线下面积（AUC）=0.858,敏感度=80.0%,特异度=81.0%,较各自单独预测的效果增强。结论 PASP及RVAW联合血肌酐在识别具有死亡风险的COPD-PH患者中具有临床价值。

关键词: COPD-PH, 预后, 肺动脉收缩压, 右室前壁厚度, 血肌酐

Abstract: Objective To assess the value of PASP and RVAW combined Scr in the prognosis of COPD-PH. Methods The COPD-PH patients admitted to People's Hospital of Ningxia Hui Autonomous Region from January to June 2021 were retrospectively analyzed and followed up 1 year after discharge, and were divided into death and survival groups according to survival status. We compared the clinical data such as general condition, laboratory indices, and echocardiographic parameters between the two groups. With death occurred in COPD-PH as the dependent variable and body mass index, pulmonary artery systolic pressure, right ventricular anterior wall thickness, right ventricular anteroposterior diameter, RDW-SD, albumin, creatinine, urea nitrogen, as well as fibrinogen degradation products as the independent variables, Logistic regression analysis was used to analyze the risk factors for COPD-PH death. ROC curves were used to assess the effectiveness of each risk factor alone and in combination to predict COPD-PH death. Results A total of 85 patients were included in this study, 26 (30.59%) in the death group and 59 (69.41%) in the survival group. Compared with the surviving,pulmonary artery systolic pressure (PASP) [65.00 mm Hg(48.25 mm Hg, 85.25 mm Hg) versus 40.20 mm Hg(36.95 mm Hg, 53.33 mm Hg)], right ventricular anterior wall thickness (RVAW) [4.10 mm(3.80 mm, 6.70 mm) versus 3.80 mm(3.60 mm, 4.00 mm)], serum creatinine (Scr) [76.50 μmmol/L(65.25 μmmol/L, 93.25 μmmol/L) versus 66.00 μmmol/L(56.00 μmmol/L, 72.00 μmmol/L)] were higher in the death group, and the differences were statistically significant. Logistic regression analysis showed an increase in pulmonary artery systolic pressure(OR=1.055, 95% CI 1.011~1.100, P=0.013), right ventricular anterior wall thickening (OR=2.321, 95%CI 1.138~4.732, P=0.021), and increased creatinine (OR=1.051, 95%CI 1.017~1.086, P=0.003) were independent risk factors for death of patients with COPD-PH. ROC curve analysis suggested that the combination of PASP+RVAW+Scr predicted the best value of COPD-PH death( AUC=0.858, sensitivity =80.0%, and specificity= 81.0%), which were enhanced compared to their respective individual predictions. Conclusion PASP and RVAW combined with Scr have clinical value in identifying COPD-PH patients at risk of death.

Key words: COPD-PH, prognosis, PASP, RVAW, serum creatinine

中图分类号:

R563.9

李慧, 白晓青, 杨静, 耑冰. PASP及RVAW联合血清肌酐在COPD-PH预后中的价值[J]. 中华养生保健, 2023, 41(22): 70-75.

LI Hui, BAI Xiao-qing, YANG Jing, ZHUAN Bing. The Value of PASP and RVAW Combined with Scr in the Prognosis of COPD-PH[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(22): 70-75.

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