慢性阻塞性肺疾病患者患肺动脉高压的风险评估分析被引量：2

Risk assessment for pulmonary hypertension in patients with COPD

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摘要目的寻找慢性阻塞性肺疾病(COPD)患者患肺动脉高压(PH)的危险因素,并试图找到各因素具有临床意义的临界值,以利于PH的筛查。方法选择符合条件的145例门诊COPD患者,均予完成肺功能检查、6 min步行距离检查、圣乔治呼吸问卷及二维超声心电图检测。设定当收缩期肺动脉血压(sPAP)>35 mmHg时认为肺动脉高压,经单因素分析、χ2趋势测试及多因素Logistic回归检验,寻找与pH相关的危险因素。结果145例中只有113例患者符合分析条件,分析显示,6MWD和sPAP之间存在负相关(r=-0.27,P=0.005),单因素分析,支气管扩张剂给予前后FEV1(P=0.05和P=0.04)、运动血氧饱和度(P=0.004)和6MWD(P=0.005)与肺动脉高压显著相关。多因素分析中,仅仅运动血氧饱和度>3%和给药前FEV1仍然与肺动脉高压有显著性相关。经χ2趋势测试及多因素Logistic回归分析结果显示,年龄>55岁,运动血氧饱和度>3%,支气管扩张剂给予前FEV1<预测值的50%,6 min步行距离<358 m时患肺动脉高压的风险增加。结论通过对年龄、运动血氧饱和度、支气管扩张剂给予前FEV1、6 min步行距离数据分析,可大致评估COPD患者患肺动脉高压(PH)的风险。【Objective】 To develop a clinical tool to identify patients who should be sent for initial screening with echocardiography.【Methods】 Of 145 outpatient with COPD were screened.All underwent full pulmonary function testing,6-minute walk distance（6MWD）,exercise oximetry,Saint George＇s Respiratory Questionnaire,and transthoracic echocardiography.Elevated PAP was defined as a systolic PAP35 mmHg.Univariate associations were determined using analysis of variance（ANOVA） for continuous variables and v2 crosstabs for categorical data.Variables that were associated with elevated PAP at P ≤0.20 were retained for multivariate analysis.【Results】 113 outpatients with COPD were enrolled.There was a negative association between 6MWD and sPAP（r =-0.27,P =0.005）.Pre-and post-bronchodilator FEV1（P =0.05 and P =0.04,respectively）,exercise oxyhemoglobin desaturation（P =0.004）,and 6MWD（P =0.005） were associated with elevated PAP on univariate analysis.In multivariate analysis,statistically significant independent variables were3% decrease in exercise oxyhemoglobin saturation and decline in prebronchodilator FEV1.All parameters were considered in a composite risk model for elevated PAP in COPD.Those variables best suited for the model included age55 years,exercise oxyhemoglobin desaturation3,prebronchodilator FEV150% predicted,and 6MWD358 m.【Conclusion】 Age,exercise oxyhemoglobin desaturation,prebronchodilator FEV1,6MWD can be used to identify whether COPD patients is at high risk for elevated PAP.

作者朱国辉李庆云冯聪锐

机构地区广州市第一人民医院老年病科

出处《中国现代医学杂志》 CAS CSCD 北大核心 2012年第23期84-87,共4页 China Journal of Modern Medicine

关键词慢性阻塞性肺疾病肺动脉高压右心导管介入术超声心电图风险评估 chronic obstructive pulmonary disease pulmonary hypertension right heart catheterization echocardiography risk assessment

分类号 R563 [医药卫生—呼吸系统]

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