The Value Of Blood Markers And Echocardiography In The Evaluation Of COPD-related Pulmonary Hypertension

Purpose : Chronic Obstructive Pulmonary Disease(COPD)causes pulmonary hypertension(PH)and eventually develops cor pulmonale and even right heart failure,which seriously affects the life and health of patients.Pulmonary hypertension is an important part of the development of COPD to cor pulmonale.Early diagnosis and prevention of pulmonary hypertension has become a hot topic of the disease.Echocardiography has important value as a screening and assessment method for patients with pulmonary hypertension.Right heart parameters can evaluate right heart function in patients with COPD-related pulmonary hypertension.This study used echocardiography combined with blood parameters to analyze patients with COPD-related pulmonary hypertension,study the relationship between these indexes and pulmonary artery pressure,explore its clinical regularity and significance,provide a theoretical basis for early diagnosis and disease assessment.Methods:A total of 117 patients diagnosed with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)were enrolled in the Second People's Hospital of Wuxi from October 2016 to February 2018.Echocardiography was performed to measure right heart parameters,including pulmonary artery systolic pressure(PASP),right atrium(RA)and right ventricular(RV)inner diameter,tricuspid annular plane systolic excursion(TAPSE),Right myocardial performance index(RMPI),etc.Record the patient's general condition(age,sex,height,weight,Course of disease,smoking,etc.)and perform blood tests including blood routine,liver and kidney function,coagulation mechanism,C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain Natriuretic peptide(NT-pro BNP),carbohydrate associated antigen 125(CA125),and so on.The pulmonary arterial systolic pressure(PASP)was measured by echocardiography,and PASP ?36 mm Hg as the standard of pulmonary hypertension.Patients were divided into two groups according to whether there was pulmonary hypertension or not.The clinical data were compared between pulmonary arterial pressure normal group(N group)and pulmonary hypertension group(PH group).Firstly,single factor analysis was performed,Then logistic regression analysis was performed to investigate the risk factors of COPD-related pulmonary hypertension.Establish a logistic forecasting model,use Receiver operating characteristic curve(ROC curve)to compare the effect of each risk factor alone or in combination on the prediction of pulmonary hypertension.Results:1.There were a total of 117 patients who had undergone echocardiography and blood tests.There were 92 males(78.6%)and 25 females(21.4%).The average age was 75.31±9.03 years.75 patients(64.1%)had normal pulmonary arterial pressure,and 42(35.9%)had pulmonary hypertension.PASP was 35(30,39)mm Hg in all patients,PASP was 32(28,35)mm Hg in patients with normal pulmonary arterial pressure,and PASP was 42(38,48)mm Hg in patients with pulmonary hypertension.There was no significant differences in age,gender,body mass index,course of disease,smoking index between the two groups(P>0.05).2.The clinical data extracted from blood tests included red blood cell distribution width(RDW),platelet distribution width(PDW),mean platelet volume(MPV),neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),C-reactive Protein(CRP),procalcitonin(PCT),D Dimer(D-D),total bilirubin(TBIL),Serum creatinine(Scr),N-terminal pro-brain natriuretic peptide(NT-pro BNP),uric acid(UA),and carbohydrate-associated antigen 125(CA125).Among them,RDW,NLR,NT-pro BNP,and CA125 were significantly different in the two groups(P<0.05).P values were 0.032,0.012,0.000,and 0.003,respectively.There were no significant differences in other blood parameters between the two groups(P>0.05).3.66 patients undergone echocardiography had complete right heart parameters.There were 37 patients with normal pulmonary arterial pressure and 29 patients with pulmonary hypertension.There was no significant differences in age,gender,body mass index,course of disease,smoking index between the two groups(P>0.05).Right myocardial performance index(RMPI)was significantly different in the two groups(P<0.05).P values was 0.000(P <0.05).There were no significant differences in other right heart parameters between the two groups(P> 0.05).4.According to the results of single factor analysis,gender,age,RDW,NLR,NT-pro BNP,CA125,RMPI were selected as independent variables,and whether there was pulmonary hypertension or not was used as the dependent variable.Logistic regression analysis was performed.The enter method was selected as the regression analysis method.The inclusion criterion was 0.05,and the rejection criterion was 0.10.Regression analysis of various factors showed that P values were 0.052,0.102,0.958,0.215,0.003,0.491,and 0.001,respectively.RMPI(OR=1.004,95% CI 1.001-1.007)and NT-pro BNP(OR=1.181,95%CI 1.068-1.305)were found being independent risk factors for pulmonary hypertension in patients with COPD.5.The ROC curve analysis showed that the threshold value of NT-pro BNP for determining pulmonary hypertension was 391.75 pg/ml,the area under the ROC curve(AUC)was 0.809.The cutoff value of RMPI for judging pulmonary hypertension was 0.485,the area under the ROC curve(AUC)was 0.797.The area under the ROC curve(AUC)of NT-pro BNP combined with RMPI was 0.932,which was greater than NT-pro BNP or RMPI alone in predicting pulmonary hypertension.Conclusion:1.Increases in RDW,NLR,NT-pro BNP,and CA125 may indicate pulmonary hypertension.Changes in these markers may be related to inflammation and oxidative stress.2.Echocardiography is a important noninvasive assessment method for pulmonary arterial pressure in patients with COPD-associated pulmonary hypertension.RMPI is more sensitive in diagnosing pulmonary hypertension and can be used to evaluate right heart function in combination with other right heart parameters.NT-pro BNP combined with RMPI can increase predicting capability of COPD-associated pulmonary hypertension.