| Research Background: Pulmonary thromboembolism is a clinical and pathological physiological syndrome due to the block of pulmonary artery or its branch by the endogenous or exogenous embolus from the venous system or right heart, which causes dysfunction of respiratory function and pulmonary circulation. When Pulmonary thromboembolism attacks alone or recurrently, which blocks the pulmonary vascular bed and the thrombosis in anticoagulation fails to dissolve completely, causes theorganization of blood clots, and then the pulmonary artery intimal thickening and luminal stenosis appears, blood flow resistance increases, eventually makes the pulmonary artery pressure increase progressively, and chronic thromboembolic pulmonary hypertension appears, then leads to right ventricular failure. This is a serious disease threats the patients’ survival quality and safety of life, with poor prognosis. If found timely inthe early days of increase of pulmonary artery pressure, it may be possible to slow down even avoid the further development of pulmonary hypertension by intervention measures. In recent years, studies have shown that the seriousness degree of pulmonary hypertension in chronic obstructive pulmonary disease combined with pulmonary hypertension and idiopathic pulmonary arterial hypertension diseases has certain correlation with the increase of uric acid. And in the process of the occurrence and development of pulmonary hypertension, nonspecific inflammation plays an important role. This study discusses whether there is a correlation between uric acid and the seriousness degree of pulmonary hypertensionand whether C-reactive protein can be used as an index to hint the seriousness degree of pulmonary hypertension in the patients with chronic thromboembolic pulmonary hypertension.Objective: To explore the variation and clinical significance of thelevel of serum uric acid, serum uric acid/creatinine ratio, C-reactive protein in chronic thromboembolic pulmonary hypertension.Methods: Select 43 patients with chronic thromboembolic pulmonary hypertension admitted by the Respiratory Department, Affiliated Chaoyang Hospital of Capital University of Medical Sciences from May 2012to July 2014, all the subjects accorded with the diagnosis standard of chronic thromboembolic pulmonary hypertension(standard involved: presented with the persistent pulmonary hypertension by cardiac ultrasound examination after 6 weeks of acute pulmonary thromboembolism), and ruled out cases with pulmonary hypertension, a history of chronic kidney disease, metabolic disease, malignant tumor, which caused by the combined chronic obstructive pulmonary disease, chronic bronchitis and connective tissue disease, and ruled out the cases which used the drugs that affect the level of serum uric acid. 25 cases are male and 18 cases arefemale, aged from 25 to 75 years old, 51.2 years old on average, 3.07 years of duration on average. Divided the patients into the mild group(SPAP 31 mm Hg-50 mm Hg), the medium group(SPAP 51 mm Hg-70 mm Hg) and the severe group(SPAP 70 mm Hg or higher) according tothe pulmonary artery pressure. There was no statistically significant difference in age, gender, etc(P>0.05) among each group. Gather the patient baseline data of routine laboratory tests and cardiac color ultrasound and analyze the baseline data in terms of correlation and carry out research by groups.Results:1 The higher the pulmonary artery pressure, the higher the serum uric acid, serum uric acid/creatinine ratio, C-reactive protein level. The pulmonary artery pressure was(31 mm Hg-50 mm Hg), uric acid level was314.94±44.9umol/l, uric acid/creatinine ratio was 4.27±0.8983, C-reactive protein was 0.5958±0.6863mg/L, the pulmonary artery pressure was(SPAP 51 mm Hg-70 mm Hg), uric acid level was 397.25±90.98umol/l, uricacid/creatinine ratio was4.54±0.7318, C-reactive protein was 1.68±3.00mg/L, the pulmonary artery pressure was(SPAP≥70mm Hg), uric acid level was 482.14±96.10umol/l, uric acid/creatinine ratio was 5.88±1.28, C-reactive protein was 3.77±4.64mg/L, and there is statistically significantdifference by the variance test.2 There is statistically significant difference in the comparison among uric acid levels, when the pulmonary artery pressure was(31 mm Hg-50 mm Hg) and uric acid level and pulmonary artery pressure were(SPAP 51 mm Hg-70 mm Hg). There is statistically significant difference in the comparison among uric acid levels, when the pulmonary artery pressure was(51 mm Hg-70 mm Hg) and uric acid level and pulmonary artery pressure were(SPAP≥70mm Hg). There is statistically significant difference in the comparison among uric acid levels, when the pulmonary artery pressure was(31 mm Hg-50 mm Hg) and uric acid level and pulmonary artery pressure were(SPAP≥70mm Hg).3 There is no statistically significant difference in the comparison among uric acid/creatinine ratio, when the pulmonary artery pressure was(31 mm Hg-50 mm Hg) and uric acid/creatinine ratio and pulmonary artery pressure were(SPAP 51 mm Hg-70 mm Hg). There is statistically significant difference in the comparison among uric acid/creatinine ratio, when the pulmonary artery pressure was(51 mm Hg-70 mm Hg) and uric acid/creatinine ratio and pulmonary artery pressure were(SPAP≥70mm Hg). There is statistically significant difference in the comparison among uric acid/creatinine ratio, when the pulmonary artery pressure was(31mm Hg—50mm Hg)and uric acid/creatinine ratio and pulmonary artery pressure were(SPAP≥70mm Hg).4 There is no statistically significant difference in the comparison among CRP, when the pulmonary artery pressure was(31 mm Hg-50 mmHg) and CRP and pulmonary artery pressure were(SPAP 51 mm Hg-70 mm Hg). There is statistically significant difference in the comparison among CRP, when the pulmonary artery pressure was(51mm Hg-70 mm Hg)and CRP and pulmonary artery pressure were(SPAP≥70mm Hg). There is statistically significant difference in the comparison among CRP, when the pulmonary artery pressure was(31 mm Hg-50 MMHG) and CRP and pulmonary artery pressure were(SPAP≥70mm Hg).Conclusion: Among the patients with chronic thromboembolic pulmonary hypertension, with the increase of pulmonary artery pressure, thereare also a rise in serum uric acid, serum uric acid/creatinine ratio and C-reactive protein. The rise degree of uric acid among different pulmonary artery pressure is different, and there is statistically significant difference, it can be used as one of the observation indexes for the elevated level of pulmonary artery. And there is also a rise in uric acid/creatinine ratio, CRP and level of pulmonary artery pressure to different extent, but it is more meaningful in patients with severe rise in the pulmonaryartery pressure by statistics analysis. To sum up, the above indexes indirectly reflect the severity of the patient condition and can be used as amonitoring index of variation clinically. |
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