The Significance Of Of Vasoactive Intestinal Peptide And D-â…¡ Polymer In Chronic Obstructive Pulmonary Disease-related Pulmonary Hypertension

Objective1. To investigate the clinical characteristics and stress related factors ofpatients with chronic obstructive pulmonary diseases (COPD) associated with pulmonaryhypertension(PH).2. Analysis the change of vasoactive intestinal peptide (VIP) in COPDassociated with PH patients,the clinical features of these patients, and to explore the role ofVIP in COPD-related PH patients.Methods1. Retrospective study of353patients with COPD，all patients were dividedinto three groups according to pulmonary artery systolic pressure(PASP) measured byechocardiography:control group<40mmHg, mild PH group40～50mmHg, moderate—severePH group≥51mmHg, Body Weight index, D一Ⅱpolymer, Pulmonary function test, diametersof main pulmonary artery(MPA) and aorta were compared among the groups．2. Select60COPD patients from November2012to April2013who hospitalized in the Ningxia People’sHospital Respiratory with acute exacerbation, according to the results of echocardiography onadmission, divided COPD-related PH group (PASP≥40mmHg), COPD non-PH group (PASP<40mmHg). Select the concurrent examination of healthy control group of30patients inNingxia People’s Hospital Medical Center. Observation COPD-related PH group, COPDnon-PH group and the healthy control group breathing, heart rate frequency; using CardiacDoppler ultrasound determine the patients pulmonary artery systolic pressure (PASP), cardiacejection fraction (EF), right atrial diameter, right atrium vertical diameter, measured the lungmiddle of the inner diameter of the pulmonary artery in patients on lung CT mediastinal window; plasma VIP levels were measured by enzyme-linked immunosorbent assay (ELISA),compare the difference of VIP level between the three groups, and observe before and afterthe treatment the change of VIP in the COPD-related PH group and COPD non-PH group, andanalyze EF values, diameter of the right atrium, right atrium and down trails and PASPwhether or not interrelate.Results1(1) Of all353patients with COPD, there are101patients associated with PH, make up28.61proportions of all patients. According to PASP measured by echocardiography, the mildPH group have74patients, the moderate—severe PH group have27patients.(2) The D一Ⅱpolymer of patients in mild PH group and the moderate—severegroup was significantly higher than that of patients in control group, and have statisticssignificance(p <0.05).(3) Compared with control group, FEV1、FVC、 FEV1/FVC、 MVV of all patientswere similar in group and moderate—severe group.(4) The MPAD of patients in mild PH group、moderate—severe group were significantlyhigher than that of patients in control group, and have statistics significance(p <0.05). The DAof patients in moderate—severe group was significantly higher than that of patients in controlgroup, and have statistics significance(p <0.05). MPAD/DA in mild PH group andmoderate—severe group are all higer than the control group,and have statistics significance(p＜0.05).2(1) Compared to COPD non-PH group and the healthy control group, the COPD-relatedPH group patients′s before treatment breathing, pulse, the middle of the inner diameter of thepulmonary artery and right atrial diameter, right atrial vertical diameter were significantlyincreased, the differences have statistically significant (P <0.05). (2) Before treatment COPD-related PH pulmonary middle diameter, vertical diameter ofthe right atrium was no significant correlation with PASP (r=0.302, r=0.372, P>0.05),hovever the right housing diameter and PASP was positively correlated (r=0.585, P <0.01)。(3) Compared with healthy controls, the plasma levels of VIP of COPD-related PH groupbefore treatment was significantly lower (P<0.01); compared with before treatment, COPDnon-PH group and PH group after treatment VIP levels were increased, the difference isstatistically significant (P>0.05). VIP level and PASP was negative correlated (r=-0.469, P<0.01).Conclusions1. COPD-related PH and non-PH plasma VIP levels were significantly reduced inpatients with acute exacerbation, and we can infer it play an important role in inflammation,also we can infer it play an important role to delay PH progress.2. The majority of PH inCOPD is mild to moderate and only few patients belong to “out of proportion”PH. There wasno direct relationship between changes in Pulmonary function and severity of PH in COPDpatients. D-Ⅱpolymer has some value to evaluate and appraise the level of PH. And the ratioof main pulmonary artery to descending aorta diameter on CT scan show excellent diagnosticvalue, can be used to screen for COPD associated with PH.3. Compared with non-PH group,COPD-related PH group patients are easier inconvenienced with heart, and when the PASPraised, the right heart also enlarge, so we can infer that have big possible to lead the rightheart get exhaustioned.