本文選題：慢性阻塞性肺疾病 + 慢性阻塞肺疾病急性加重期��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)觀察慢性阻塞性肺疾病急性加重期(AECOPD)合并肺動(dòng)脈高壓(PH)患者中呼出氣一氧化氮(FeNO)的濃度變化,探討其在AECOPD合并PH患者診治中的臨床意義。方法:選取2015年12月至2017年1月就診于哈勵(lì)遜國(guó)際和平醫(yī)院呼吸內(nèi)科的AECOPD患者,符合入選標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的患者共119名,均簽署知情同意書(shū),記錄其性別、年齡等一般情況。所有入選患者均于入院用藥前檢測(cè)其FeNO濃度。采用心臟超聲檢查檢測(cè)其有無(wú)肺動(dòng)脈高壓,并估測(cè)其肺動(dòng)脈壓力(PASP)。記錄相應(yīng)數(shù)據(jù),同時(shí)于患者住院過(guò)程中繼續(xù)監(jiān)測(cè)有無(wú)合并影響FeNO結(jié)果的其他疾病,對(duì)此類患者進(jìn)行排除。經(jīng)過(guò)逐一排查最終共有71名AECOPD患者納入本研究,其中AECOPD組48例,AECOPD合并PH組23例。按估測(cè)的肺動(dòng)脈壓力將AECOPD合并PH組患者分為PH輕度、PH中度及PH重度組。記錄同期兩組患者各項(xiàng)檢查結(jié)果包括血?dú)夥治�、肺功能指�?biāo)、C-反應(yīng)蛋白(CRP)及腦鈉肽(BNP)水平。于患者出院時(shí)記錄其住院時(shí)間以及有無(wú)行有創(chuàng)機(jī)械通氣治療。用統(tǒng)計(jì)學(xué)方法比較兩組患者FeNO水平,并進(jìn)一步探查FeNO濃度與PH嚴(yán)重分度是否存在一定相關(guān)性。比較兩組患者其它各項(xiàng)指標(biāo)的差異,并探索FeNO水平與其它各項(xiàng)指標(biāo)之間的關(guān)系。進(jìn)一步探討FeNO濃度變化在AECOPD合并PH患者中的應(yīng)用。結(jié)果:1 AECOPD組患者與AECOPD合并PH患者在年齡、性別、血?dú)夥治觥獾雷枞潭燃坝袆?chuàng)機(jī)械通氣率間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。但兩組患者FeNO水平、CRP和BNP水平以及住院時(shí)間之間存在統(tǒng)計(jì)學(xué)差異,AECOPD合并PH患者FeNO水平更低,CRP及BNP水平更高,住院時(shí)間更長(zhǎng)(P0.05)。2按估測(cè)的肺動(dòng)脈壓力對(duì)PH嚴(yán)重程度進(jìn)行分度,PH輕度組FeNO水平高于PH中度及PH重度組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);但PH中度與PH重度組FeNO水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3對(duì)FeNO與PH嚴(yán)重程度進(jìn)行相關(guān)性分析發(fā)現(xiàn)FeNO水平與PH嚴(yán)重程度呈負(fù)相關(guān)(r=-0.616,P=0.002),PH越嚴(yán)重,FeNO水平越低。4通過(guò)ROC曲線發(fā)現(xiàn),FeNO水平在診斷AECOPD患者是否合并肺動(dòng)脈高壓的截?cái)嘀禐?4.5ppb,敏感度為66.7%,特異度為82.6%。5 FeNO水平與BNP、CRP存在一定的相關(guān)性,在不合并PH的AECOPD患者中,FeNO水平與CRP呈正相關(guān)(r=0.407,P=0.004),與BNP無(wú)顯著相關(guān);AECOPD患者合并PH時(shí),FeNO水平和CRP呈負(fù)相關(guān)(r=-0.744,P0.001),與BNP也呈負(fù)相關(guān)(r=-0.619,P=0.002)。結(jié)論:1 AECOPD合并PH時(shí),FeNO水平顯著低于未合并PH的AECOPD患者,并且FeNO水平與PH嚴(yán)重程度呈負(fù)相關(guān),PH嚴(yán)重程度越重,FeNO水平越低;2 FeNO對(duì)AECOPD是否合并肺動(dòng)脈高壓具有一定診斷價(jià)值;3 AECOPD不合并PH時(shí),FeNO水平與CRP呈正相關(guān),與BNP無(wú)顯著相關(guān);4 AECOPD患者合并PH時(shí),FeNO水平和CRP及BNP均呈負(fù)相關(guān)。
[Abstract]:Objective: to observe the changes of exhalation nitric oxide (FeNO) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pulmonary hypertension (PH), and to explore its clinical significance in the diagnosis and treatment of AECOPD with PH. Methods: 119 patients with AECOPD from December 2015 to January 2017 in Department of Respiratory Medicine, Harrison International Peace Hospital, who met the criteria of inclusion and exclusion, all signed informed consent letters and recorded their gender, age and other general information. All patients were tested for FeNO concentration before admission. Pulmonary artery pressure (PASP) was evaluated by echocardiography. Record the corresponding data and continue to monitor if there are any other diseases that affect Feno outcome during hospitalization. A total of 71 AECOPD patients were included in this study, including 48 patients with AECOPD and 23 patients with PH. Patients with AECOPD complicated with PH were divided into moderate PH group and severe PH group according to the estimated pulmonary artery pressure. The results of blood gas analysis, lung function index, C-reactive protein (CRP) and brain natriuretic peptide (BNP) were recorded. The duration of hospitalization and the availability of invasive mechanical ventilation were recorded at the time of discharge. The levels of FeNO in the two groups were compared by statistical method, and the correlation between FeNO concentration and PH severity was further explored. To compare the difference of other indexes between the two groups and to explore the relationship between FeNO level and other indexes. To investigate the application of Feno concentration in patients with AECOPD complicated with PH. Results there was no significant difference in age, sex, blood gas analysis, airway obstruction degree and invasive mechanical ventilation rate between the two groups (P0.05). However, there were significant differences between the two groups in the levels of CRP and BNP and the length of stay. The levels of FeNO and BNP in patients with PH and AECOPD were lower, and the levels of CRP and BNP were higher than those in patients with PH. The duration of hospitalization was longer (P0.05) .2 FeNO level in mild PH group was higher than that in moderate and severe PH group. The difference was statistically significant (P0.05), but there was no significant difference in FeNO levels between moderate and severe PH groups (P0.05). 3. The correlation analysis between FeNO and PH severity showed that FeNO level was negatively correlated with PH severity (r 0. 616 P0. 002). The more severe PH was, the more serious FeNO level was. The lower the ROC curve was, the lower the ROC curve showed that the truncation value, sensitivity and specificity of Feno in diagnosis of pulmonary hypertension in AECOPD patients were 24.5 ppb, 66.7, and 82.6%, respectively, and there was a certain correlation between FeNO level and BNP-CRP. In AECOPD patients without PH, the level of FeNO was positively correlated with CRP (r = 0.407, P0. 004). There was no significant correlation between FeNO level and CRP in AECOPD patients with PH (r-0.744P0.001), and a negative correlation between FeNO level and BNP (r-0.619P0. 002). Conclusion the level of FeNO in patients with PH was significantly lower than that in patients without PH. There was a negative correlation between FeNO level and PH severity. The more severe PH was, the lower FeNO level was. FeNO had a certain diagnostic value for AECOPD complicated with pulmonary hypertension. There was a positive correlation between FeNO level and CRP when AECOPD was not associated with PH. There was no significant correlation with BNP. The level of FeNO in patients with PH was negatively correlated with CRP and BNP.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9;R544.1

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