| Objective:Pulmonary hypertension was the key of chronic obstructive pulmonary disease to a certain stage and secondary to pulmonary heart disease,pulmonary vascular resistance progressively increased was its main feature,it can lead to right ventricular failure,activity tolerance and life quality of patients was lower significantly,and because of its non-specific symptoms,often leading to delays in diagnosis.To analyze the medical records of chronic obstructive pulmonary disease(COPD)patients with secondary pulmonary hypertension retrospectively,and analyze the risk factors for pulmonary hypertension,provide convenience for early detection and early intervention.Method: Select 3539 cases medical records of COPD patients in our hospital from March 2004 to September 2015,and divided into COPD secondary to pulmonary hypertension group,and simple COPD group.All patients met the diagnostic criteria for chronic obstructive pulmonary disease and chronic obstructive pulmonary disease treatment guidelines(2013 Revision)enacted.Pulmonary hypertension secondary to chronic obstructive pulmonary disease diagnosis following indicators: patients with cardiac ultrasound found to comply with the 2009 European Society of Cardiology and the diagnosis of pulmonary hypertension treatment guidelines in the diagnostic criteria,namely echocardiography to estimate pulmonary artery pressure ?35mmHg;patients with confirmed lung CT the diameter of the main pulmonary artery or main pulmonary artery diameter line ?29mm / aortic diameters> 1: 1;exclusion of other causes of pulmonary hypertension.Organized the medical records of all patients,counted the general information(age,sex,place of residence,within a year the number of attacks,duration,smoking status)and laboratory detection index(white blood cell count,the ratio of neutrophils in patients with hematocrit,creatine kinase isozyme,?-hydroxybutyrate dehydrogenase,fibrinogen,brain natriuretic peptide)by grouping,and regression analysis studies to assess risk factors for COPD patients with pulmonary hypertension.Statistical analyzes were performed using IBM SPSS 22.0 statistical software.Measurement data not normally distributed,using the median(M)and interquartile ranges(QR);using two-sample Wilcoxon rank sum test between the two groups.Count data using statistical description proportions described;chi-square test or two-sample Wilcoxon rank sum test between the two groups.Whether factors COPD with pulmonary hypertension was analyzed by logistic regression analysis.Significance level ? = 0.05.Results: 3539 cases patients were divided into two groups,one group with pulmonary hypertension secondary to chronic obstructive pulmonary disease 801 cases,2738 cases in the control group.1 The contrast between the two groups of age,the median age of pulmonary hypertension secondary to chronic obstructive pulmonary disease group was 70.00 years,median age of the control group was 71.00 years,data comparison P= 0.476,no significant difference;2 The contrast of gender between the two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group,588 cases of male,213 cases of female,1971 cases of male in control group,767 cases of female,between two groups P= 0.429,there was no significant difference;3 The place of residence between the two groups,two patients are not available or can not be distinguished career living or working environment,not in the statistics;461 cases non-townsfolk and 338 cases townsfolk in pulmonary hypertension secondary to chronic obstructive pulmonary disease group,1349 cases non-townsfolk and 1389 cases of townsfolk in control groups,between two groups P<0.001,the difference was statistically significant;4 The contrast of episodes number in a year between the two groups,661 cases episodes once a year,140 cases episodes twice at least in pulmonary hypertension secondary to chronic obstructive pulmonary disease group,2307 cases episodes once a year,430 cases episodes twice at least in the control group,between two groups P= 0.231,no significant difference;5 Distribution of disease duration between the two groups,patients were analyzed according to 10 years at least,11--20 years,21--30 years,31--40 years,more than 40 years,a total of 83 patients were unable to provide a more accurate history of the length,of the rest 3456 patients,pulmonary hypertension secondary to chronic obstructive pulmonary disease group consisted of 776 cases,according to the above criteria were 331 cases,196 cases,123 cases,79 cases,47 cases,the control group 2680 cases,according to the above criteria,respectively,1224 cases,703 cases,395 cases,214 cases,144 cases,between two groups P= 0.040,the difference was statistically significant;6 The number of smokers and non-smokers between two groups had no significant difference(P> 0.05),but the smoking index of COPD patients with pulmonary hypertension group was higher than COPD group,the difference was statistically significant(P <0.05).7 The contrast of white blood cell count(WBC)between the two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group consisted of 732 cases,2536 cases of the control group,two groups comparison P <0.001,the difference was statistically significant;8 The contrast of neutrophils ratio(NE%)between the two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group consisted of 766 cases,2623 cases of the control group,two groups comparison P <0.001,the difference was statistically significant;9 Hematocrit(HCT)contrast between two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group 257 patients,a total of 817 cases in the control group,between two groups P <0.001,statistically significant;10 Creatine kinase MB(CK-MB)contrast between two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group 585 patients,a total of 1554 cases in the control group,between two groups P<0.001,statistically significant;11 ?-hydroxybutyrate dehydrogenase(HBDH)contrast between two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group 486 patients,a total of 1706 cases in the control group,between two groups P <0.001,statistically significant;12 Platelet(PLT)contrast between two groups,pulmonary hypertension secondary to chronic obstructive pulmonary disease group 754 patients,a total of 2607 cases in the control group,between two groups P<0.001,statistically significant;13 Blood gas analysis contrast between two groups,there were 3327 cases of patients in all,769 cases in one group of pulmonary hypertension secondary to chronic obstructive pulmonary disease,some patients can not be part of the statistical data by the fuzzy in the control group,it can provide a PH value cases 3304 cases,3327 cases provide Pa O2 value cases,provide value PaCO2 cases 3325 cases,three indicators between two groups,PaCO2 group P <0.001,statistically significant,PaO2 group P>0.05 no significant difference,PH group,P = 0.007,statistically significant;14 Brain natriuretic peptide(BNP),uric acid(UA),fibrinogen(Fib)packet,calculate P>0.05,no significant difference;15 By regression analysis,townsfolk suffering from COPD with pulmonary hypertension risk is 0.657 times of non-townsfolk;?2 episodes a year suffer from COPD with pulmonary hypertension was 1.337 times of episodes once a year;WBC abnormal increase was 1.516 times of WBC normal;NE abnormal increase was 1.619 times of NE normal;PH abnormal decrease was 1.376 times of the normal PH,PH abnormal increase was 1.508 times of the normal PH;PaCO2 abnormal increase was 1.547 times of PaCO2 normal.Conclusion:1 Patients with pulmonary hypertension secondary to COPD compared with the simple COPD patients,there is no statistically significant difference in age,gender,suggesting that these factors can not be seted as a prediction of pulmonary hypertension secondary to COPD basis in a sense;2 Patients with COPD secondary to pulmonary hypertension compared with the control group,there are significant differences in the place of residence,duration,WBC,NE%,HCT,CK-MB,HBDH,PaCO2,PLT value,pH,the erythrocyte sedimentation rate,non-townsfolk,longer course patients and NE%,WBC,HCT,CK-MB,HBDH,PaCO2,PLT values,pH,lower erythrocyte sedimentation rate abnormal patients has high possibility to pulmonary hypertension,suggesting those factoes can be seted as a predictor for pulmonary hypertension secondary to COPD;3 Through logistic regression analysis,non-townsfolk,NE% abnormal increase,WBC abnormal increase,pH increase or decrease abnormal and PaCO2 abnormally elevated is risk factors of COPD with pulmonary hypertension,PLT abnormal decrease is protective factors of COPD with pulmonary hypertension... |
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