The Relationship Between RDW,NLR,Cys-C And Chronic Obstructive Pulmonary Disease (COPD) Associated Pulmonary Hypertension

Objective: Discuss the application value of RDW,NLR,Cys-C in patients with COPD associated pulmonary hypertensionMethods: Collecting 154 patients with COPD associated pulmonary hypertension who were hospitalized in Dalian medical University second affiliated hospital from January,2012 to October,2016 to form a pulmonary hypertension experimental group.The 82 patients are male,and the rest 72 are female.They are at an average age of 68(from 66 to 77).According to the Pulmonary systolic pressure,they are divided to 3 groups,among whom,65 are with light pressure,46 are with moderate pressure,and 43 are with heavy pressure.Finding118 patients only with COPD but no pulmonary hypertension(COPD group)with average age at 68.5 years old(from 61 to 74 years old),consisting of 62 males and 56 females.Choosing 105 people who are attested to be healthy by Medical Examination Center(MEC)at the same time that are at the average 66.5 years old(from 55 to 79 years old)as the healthy group.There are 56 males and 49 females in this healthy group.For each group,recording the members' general data,echocardiographic index,peripheral blood WBC,NEU,LYM,then calculating NLR and RDW,RBC,D-D,Cr,Cys-c,Pa O2,Pa CO2.Examining and comparing the index among three groups by Mann-Whitney U method,analyzing blood index and predicating PH accuracy by using binary-logistic regression and subjects ROC,using Spearman test to analyze the relevance between related blood index and pulmonary systolic pressure.Results: 1.RDW,NLR,Cys-C are higher in COPD group than in healthy group,butPulmonary hypertension group is higher than COPD group.The differences are statistically significant(p<0.05).2.Among pulmonary hypertension patients with different degrees of pressure,RDW,Cys-C are highest in heavy pressure group,and moderate group is higher than light group.The differences are statistically significant(p<0.001).However,the differences of NLR between the three groups are not statistically significant(p>0.05).3.Analyzing RDW,NLR,Cys-C separately and jointly by ROC.The AUC of RDW is the highest(0.769).When the limit value is 13.65%,its sensibility is 57.10%,and specificity is 87.9%.When the AUC of NLR and Cys-C are 0.738 and 0.713,their sensibility are 76.6% and 58.4%,and specificity are 63.6% and 86.9% respectively.Using binary-logistic regression analysis equation to build up a risk prediction model of pulmonary hypertension,then analyzing RDW,NLR,Cys-C separately and jointly by ROC.When RDW and NLR are jointed,the AUC value is the highest as 0.831.At the same time,the sensibility is 65.6%,and the specificity is 89.9%.When RDW and Cys-C are jointed,the AUC value is 0.811,then get the sensibility is 63.0%,and the specificity is 88.9%.When NLR and Cys-C are jointed,the AUC value is 0.808,then get the sensibility is 77.3%,and the specificity is 76.8%.When the three are jointed together,the peak value of AUC is 0.852,followed with the sensibility to be 72.1%,specificity to be 87.9%,which has better diagnostic performance than a single index or two two combination index.4.In pulmonary hypertension group,making a linear correlation analysis among RDW,NLR,Cys-C,D-Dimer,Pa O2 and pulmonary systolic pressure.The result shows RDW,Cys-C,D-Dimer are correlated positively with pulmonary systolic pressure,and the correlation coefficient are 0.462,0.407,0.259(P<0.05)respectively.With the increase of pulmonary systolic pressure value,RDW,Cys-C,D-Dimer are rising in level.Pa O2 and pulmonary systolic pressure are negatively correlated(r=-0.301,p<0.05).That means,the value of pulmonary systolic pressure is higher,the Pa O2 value is lower.There are no obvious correlation between NLR and pulmonary systolic pressure(p>0.05).Using binary-logistic regression analysis equation to build up a riskprediction model between pulmonary hypertension and COPD,then making a correlated analysis between Synthetic prediction probability and pulmonary systolic pressure value.The result shows synthetic prediction probability and pulmonary systolic pressure degrees are positively correlated,the correlation coefficient r=0.56,p<0.05.This correlation is better than that between a single index and pulmonary hypertension.Conclusions: 1.RDW,NLR,Cys-C in COPD associated pulmonary hypertension is obviously higher,and it has better diagnostic performance than a single index when tested the three jointly.RDW and Cys-C has correlation with the severity of pulmonary hypertension,and joint test will be more accurate.