The Preliminary Exploration Of The Fractional Concentration Of Exhaled Nitric Oxide In Patients With AECOPD And Pulmonary Hypertension

Objective: Through the observation of the fractional concentration of exhaled nitric oxide(FeNO)in patients with Acute exacerbation of chronic obstrctive pulmonary disease(AECOPD)and pulmonary hypertension(PH),investigate its clinical significance in the diagnosis and treatment of patients with AECOPD and PH.Methods: Patients with AECOPD hospitalized in respiration medicine of Harrison international Peace Hospital from December 2015 to January2017 were selected,and there were totally 119 patients who got through all the inclusion criteria and the exclusion criteria.All patients in this study should sign an informed consent.Record their general information such as gender,age,etc.All the participants should perform FeNO testing before all treatment when hospitalized.Using ultrasonic cardiogram to detect whether they combined with pulmonary hypertension,and estimate the pulmonary arterial systolic pressure(PASP)of patients with PH.Record corresponding data and meanwhile,continue monitoring whether the patients selected have other illness which can affect the level of FeNO,and such patients should be ruled out.At last,a total of 71 patients with AECOPD were enrolled in this study,of which AECOPD group of 48 cases and AECOPD combined with PH group of 23 cases.According to the estimated PASP,patients in AECOPD combined with PH were divided into mild PH,moderate PH and severe PH.At the same time,record other results including blood gas analysis,pulmonary function index,C-reactive protein(CRP)and brain natriuretic peptide(BNP)levels,and record hospital stays and whether they have perform the trachea intubation when discharged.Compare the FeNO levels of the two groups by statistical methods and explore whether there was a certaincorrelation between FeNO level and the severity of PH.Compare the difference of other results in the two groups and explore the relationship between FeNO level and other indexes.Investigate the applications of FeNO in patients with AECOPD.Results:1 There was no significant difference in age,sex,blood gas analysis,degree of airway obstruction and the rate of trachea intubation between the two groups(P>0.05).However,there exist a statistical difference in FeNO level,CRP and BNP level and hospital stays between the two groups,patients of AECOPD combined with PH have a lower FeNO level,higher CRP and BNP levels and longer hospital stays(P<0.05).2 According to the estimated PASP,patients of AECOPD combined with PH were divided to different degrees and the level of FeNO in mild PH is higher than moderate PH and severe PH,the differences were statistically significant(P<0.05),but there was no significant difference in FeNO levels between moderate PH and severe PH(P>0.05).3 After a correlation analysis we found that the level of FeNO was negatively correlated with the severity of PH(r=-0.616,P=0.002),the more severe of PH,the lower level of FeNO.4 The ROC curve showed that the cut-off score of FeNO level in the diagnosis of patients with AECOPD whether combined with pulmonary hypertension was 24.5ppb,the sensitivity was 66.7%,and specificity was82.6%.5 We also found there exist a correlation between FeNO and BNP?CRP,in patients of AECOPD without PH,FeNO level was positively correlated with CRP(r=0.407,P=0.004),and no significant correlation with BNP;in patients of AECOPD combined with PH,we found that FeNO and CRP levels were negatively correlated(r=-0.744,P < 0.001),and BNP was also negatively related(r=-0.619,P=0.002).Conclusions:1 When patients of AECOPD combined with PH,FeNO levels weresignificantly lower than those of patients without PH,and the level of FeNO was negatively correlated with the severity of PH,the more severe of PH,the lower level of FeNO;2 There exists a certain significance in using FeNO to diagnose whether a AECOPD patient combined with pulmonary hypertension;3 In patients of AECOPD without PH,FeNO levels are positively correlated with CRP,and no significant correlation with BNP;4 In patients of AECOPD combined with PH,FeNO levels are negatively correlated with CRP,and negatively correlated with BNP.