The Significance Of PAF,PAF-AH, Uric Acid In COPD-related Pulmonary Hypertension

Objective To explore the etiology composition of pulmonary hypertension(PH) inpatients of respiratory department, and analysis their clinical features and related factors with pulmonary arterial pressure. In addition, investigating the blood platelet-activating factor(PAF) and platelet-activating factor acetylhydrolase(PAF-AH) levels in chronic obstructive pulmonary disease(COPD) patients with and without PH, to explore the significance of PAF and PAF-AH in COPD-related PH.Methods(1) According to the newest amend of PH classification in 2008, we analysis the etiology composition of the 127 PH inpatients from Ning Xia People’s Hospital respiratory department, and their clinical characters and related factors of pulmonary arterial pressure are analyzed.(2) Selecting 30 patients of COPD with PH as COPD with PH group, and 30 patients of COPD without PH as COPD without PH group, Every patient of two groups got conventional therapy(oxygen therapy, spasmolysis, antiasthma, anti-infection, if patients with cardiac dysfunction should be given diuresis, cardiotonic besides above mentioned). 25 healthy persons were taken as control group at the same period. The plasma PAF and serum PAF-AH of three groups were detected by Enzyme linked immunosorbent assay(ELISA). To compare the levels of plasma PAF and serum PAF-AH in three groups, and observing the changing of plasma PAF and serum PAF-AH before and after treatment, then analysis the correlation beween plasma PAF,serum PAF-AH levels and pulmonary artery systolic pressure(PASP).Results1. The etiology composition of PH inpatients of respiratory department: 76.38% PH were owing to lung diseases and/or hypoxia, and COPD was the most frequent cause of the PH owing to lung diseases and/or hypoxia, accounting for 67.01%, 7.87% PH originat from thrombotic or embolic disease,7.87% from left heart disease,6.31% to pulmonary arterial hypertension(PAH), and 1.57% from unclear multifactorial mechanisms.2. The most common clinical symptom was cough(88.98%), then expectoration(85.83%), dyspnea(81.89), the most common complication was respiratory failure(53.54%).The descent of arterial partial pressure of oxygen(Pa02) and elevation of uric acid(UA), red blood cell count(RBC), hemoglobin(HGB) were related with pulmonary artery pressure.3. Linear correlation analysis showed that PASP was negatively correlated with Pa02(r=-0343,P<0.01), and was positively correlated to the course of disease, UA, RBC as well as HGB(r =0.309,0.356 and 0.222 respectively,all P<0.05).4. Before treatment, compared with the control group, the plasma PAF of COPD with PH group and without PH group were prominent higher(all P<0.01); the levels of plasma PAF of PH group was prominent higher than without PH group(P<0.01), The levels of serum PAF-AH of COPD with PH group and without PH group were lower than the healthy control group(all P<0.05), and the levels of serum PAF-AH of PH group lower than without PH group(P<0.01).5. Compared to that before treatment, through treatment, and plasma PAF levels decreased prominent in COPD with PH group and COPD without PH group(t=3.966, 5.589 respectively, all P<0.01), but the levels of serum PAF-AH were increased(t=-5.506,-3.481 respectively, all P<0.01).The PASP of PH group were lower(t=3.570, P<0.05). After treatment, the levels of plasma PAF in PH group were pronounced higher than COPD without PH group(t=3.659,P<0.01), and the serum PAF-AH were lower(t=-7.276,P<0.01)6. Before and after treatment, linear correlation analysis showed that plasma PAF levels of COPD with PH group were positively correlated with the PASP(r=0.772、0.760,all P <0.01), the serum PAF-AH levels were negatively(r=-0.663、-0.538,all P<0.05)。Conclusion1. The etiology of PH inpatients of respiratory department were various, and lung diseases and/or hypoxia was the most common cause. The common clinical symptoms were cough, expectoration and dyspnea. And respiratory failure was the most common complication. The descent level of Pa02, and the upgrade of UA, RBC and HGB may be have some relationship with the severity of PH.2. The PAF and PAF-AH had an important role in COPD-related PH, as proinflammatory and anti-inflammatory factors respectively, and their percentage disbalance in acute exacerbation of COPD maybe contribute to the process of PH.