Clinical Significance Of Ankle-brachial Index In Patients With Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Hypertension

Objective:To investigate the correlation of ankle-brachial index,pulmonary function,inflammatory index,coagulation function and severity of PH in patients with chronic obstructive pulmonary disease(Chronic Obstructive Pulmonary Disease,COPD) complicated with pulmonary hypertension(Pulmonary Hypenension,PH).It provides the basis for clinical evaluation of the condition and prognosis of the patients.Methods:A total of 148 patients with COPD were selected from the Department of Respiratory Medicine,the affiliated Hospital of Nanchang University.The general clinical data of the patients were recorded,and the erythrocyte count(RBC),platelet(PLT),erythrocyte distribution width SD(RDW-SD)was collected.Mean platelet volume(MPV),C reactive protein(CRP),neutrophil percentage(NE%),eosinophilic granulocyte percentage(EO%),uric acid(UA),albumin(ALB),D-dimer(D-D),Fibronectin(FIB),brain natriuretic peptide(BNP),calcitonin(PCT),erythrocyte sedimentation rate(ESR),forced breath volume in the first second of the predicted value(FEV1% pred) and other indicators;Four electronic sphygmomanom-eters of the same type were used to measure the blood pressure of the extremities of the patients at intervals of 2 minutes.the mean values were taken and the ankle brachial index(ABI);was calculated.The pulmonary artery systolic blood pressure(PASP),was estimated by color Doppler echocardiography.According to the results of PASP,the patients were divided into simple COPD group(PASP ≤ 35 mmHg),COPD with PH group(PASP > 35mmHg).COPD with PH group was divided into three subgroup:mild PH group(PASP:36~50mmHg),moderate PH group(PASP:51~70mmHg) and severe PH group(PASP > 70mmHg).The correlation between ABI and PH severity was statistically analyzed.Results:There was no significant difference in gender,diabetes history,hypertension history,coronary heart disease history,RBC,NE%,EO%,ALB,PCT and ejectionfraction(LVEF) among groups(P>0.05).The age in COPD with severe PH group was significantly lower than that in simple COPD group,COPD with mild PH group and moderate PH group(P < 0.05).The smoking rate in COPD with mild PH group was significantly higher than that in COPD group(P < 0.05).CRP,BNP in COPD with moderate and severe PH group was significantly higher than that in simple COPD group and COPD with mild PH group(P < 0.05).UA,RDW-SD in COPD with severe PH group was significantly higher than that in simple COPD group and COPD with mild PH group(P < 0.05),PLT in COPD group was significantly higher than that in COPD with moderate and severe PH group(P < 0.05).ESR,MPV in simple COPD group was significantly lower than that in COPD with moderate and severe PH group(P < 0.05),and D-D in COPD group was significantly lower than that in COPD with mild and severe PH group(P <0.05).With the increase of PH,FIB increased gradually,and the difference between COPD and severe PH group was significantly higher than that in COPD group(P <0.05).RA,RV increased with the increase of PH,and the RA of PD with moderate and severe PH group was significantly higher than that of simple COPD group and COPD with mild PH group,and the difference was statistically significant(P < 0.05).The RV of COPD with severe PH group was significantly higher than that of simple COPD group,COPD with mild and moderate PH group,the difference was statistically significant(P < 0.05).With the increase of PH severity,ABI decreased gradually.ABI in COPD group was higher than that in other groups,and the difference was statistically significant(P < 0.05).FEV1%pred in COPD group was significantly higher than that in COPD with mild PH group,COPD with moderate and severe PH group(P < 0.05).Pearson correlation analysis showed that the severity of pulmonary hypertension was negatively correlated with age and PLT,FEV1%pred,ABI,and positively correlated with CRP,RDW-SD,RA,RV,UA,BNP(P < 0.05).Taking pulmonary artery systolic blood pressure as independent variable and dependent variable as dependent variable,only six factors(age,CRP,RDW-SD,UA,RV,ABI) were selected for regression equation by multiple regression analysis.Conclusion:1.The existence of high level of CRP,UA,ESR,D-D,FIB,in patients with COPD with PH suggests that inflammatory factors and blood hypercoagulation may be involved in the disease process of patients with COPD with PH.2.There was a low ABI and FEV1% pred in patients with COPD with PH and a negative correlation with the pulmonary artery systolic pressure,which could be used as a reference for assessing the severity of patients with COPD with PH.