Application Value Of Inflammatory Factors In AECOPD Complicated With Pulmonary Hypertension

Objective:To investigate the application value of inflammatory factors in AECOPD complicated with pulmonary hypertension,compared the levels of inflammatory factors in patients with or without pulmonary hypertension in AECOPD and analyzed the correlation between inflammatory factors and PASP or OI,so as to provide the evidence for diagnosis and prognosis assessment.Methods:A total of 113 patients with AECOPD who were admitted to the Respiratory Department of the First Affiliated Hospital of Kunming Medical University from September 1,2020 to September 30,2022 were collected as the research objects.Transthoracic echocardiography was performed in all patients and the results were recorded.A total of 69 AECOPD patients were study group and forty-four AECOPD patients were the control group according to whether they had pulmonary hypertension or not.In the study group,pulmonary arterial systolic pressure was further divided into mild pulmonary hypertension group and moderate to severe pulmonary hypertension group.Arterial blood gas analysis outcomes（PCO₂,PO₂）and venous blood collection indexes（including RDW,HB,N%,NEUT,LYM,Cr,Alb,D-D,CRP,BNP,IL-6,IL-8,IL-10,TNF-α,CA125,etc.）were collected after admission,and calculated the OI=oxygen partial pressure/oxygen absorption concentration and NLR=neutrophil absolute value/lymphocyte absolute value.SPSS25.0 statistical software was used to analyze and process the research data.Results:1.Comparison between AECOPD group and AECOPD complicated with PH group:there were no significant differences in gender composition,age,length of hospital stay,body mass index and smoking index between the two groups（P>0.05）.The levels of BNP,RDW,N%,NLR,CRP,D-D,IL-6 and CA125 in AECOPD-PH group were significantly higher than those in AECOPD group,while the levels of EOS and Alb were significantly lower than those in AECOPD group,with statistical significance（P<0.05）.There were no significant differences in Hb,Cr,IL-8,IL-10and TNF-αbetween the two groups（P>0.05）.OI of AECOPD-PH group was significantly lower than that of AECOPD group,the difference was statistically significant（P<0.05）,but there were no significant differences in the levels of PCO₂,PO₂,FEV1%Pred and FEV1/FVC between the two groups（P>0.05）.2.Comparison of different PH groups:There were no significant differences in gender composition,age,length of stay,body mass index and smoking index between mild PH group and moderate to severe PH group（P>0.05）.Compared with patients with mild PH,the levels of BNP,RDW,D-D and IL-6 were significantly increased in patients with moderate and severe PH,and the difference was statistically significant（P<0.05）,while the levels of EOS,N%,Hb,NLR,CRP,Alb,Cr,IL-8,IL-10,TNF-αand CA125 were not significantly different between the two groups（P>0.05）.OI and FEV1%Pred decreased and PCO₂increased in patients with moderate and severe PH,the difference was statistically significant（P<0.05）,and there was no significant difference in the levels of PO₂and FEV1/FVC between the two groups（P>0.05）.3.The correlations between OI and PASP with the indexes statistically significant were analyzed respectively:PASP was positively correlated with age,BNP,RDW,N%,NLR,CRP,D-D,IL-6,CA125,and negatively correlated with EOS,Alb,OI（P<0.05）;OI was negatively correlated with BNP,RDW,NLR and IL-6（P<0.05）,but there were no correlation with age,EOS,N%,CRP,D-D,Alb and CA125（P>0.05）.4.Binary logistic regression analysis of risk factors for AECOPD complicated with PH showed that BNP and NLR were independent risk factors for AECOPD concurrent PH.5.SPSS25.0software was used to draw ROC curve to explore the predictive value of BNP,NLR and IL-6 to AECOPD combined PH:the AUC of BNP was 0.777,the sensitivity was 0.812,and the specificity was 0.659.The AUC of NLR was 0.691,the sensitivity was 0.478,and the specificity was 0.864.The AUC of IL-6 was 0.673,the sensitivity was 0.507,and the specificity was 0.841.It is suggested that BNP,NLR and IL-6 all have predictive value for AECOPD combined PH,but the prediction effect of BNP is due to the other two factors.When the cut-off point is 28.57,BNP has higher sensitivityConclusion:1.The levels of BNP、RDW、NLR and IL-6 were higher in patients with AECOPD complicated with pulmonary hypertension than those in patients with AECOPD alone,and were positively correlated with pulmonary artery pressure,which could indirectly reflect the degree of inflammation in patients with AECOPD complicated with pulmonary hypertension.2.Hypoxia and inflammation were more severe in patients with AECOPD complicated with pulmonary hypertension,both of which are important characteristics of AECOPD complicated with pulmonary hypertension.OI was negatively correlated with serum BNP,RDW,NLR,and IL-6 levels,suggesting a potential interaction between hypoxia and inflammation.Further research into the mechanism may help us understand the development of PH.3.BNP and NLR were independent predictors of AECOPD complicated with pulmonary hypertension,and BNP had better predictive ability than NLR.