| 陈刚.慢阻肺急性加重期患者肺小血管定量参数联合血清基质细胞衍生因子-1水平预测肺动脉高压的价值[J].安徽医药,待发表. |
| 慢阻肺急性加重期患者肺小血管定量参数联合血清基质细胞衍生因子-1水平预测肺动脉高压的价值 |
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| 投稿时间：2026-04-25 录用日期：2026-05-20 |
| DOI： |
| 中文关键词: 慢性阻塞性肺疾病 急性加重 肺小血管 定量参数 基质细胞衍生因子-1 肺动脉高压 |
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| 中文摘要: |
| 目的 探讨慢性阻塞性肺疾病(COPD)急性加重期患者肺小血管定量参数联合血清基质细胞衍生因子-1(SDF-1)水平预测肺动脉高压(PH)的价值。方法 选取2021年1月到2024年12月医院收治的98例COPD急性加重期患者为研究对象,依据是否合并PH分为无PH组(63例)、合并PH组(35例)。多层螺旋CT测定肺小血管横截面积(CSA),分别计算CSA＜5、CSA 5~10与肺总CSA 的比值(记为%CSA＜5、% CSA5~10)；酶联免疫吸附法检测血清SDF-1水平。收集并对比2组基本资料及CSA、SDF-1差异。Logistic回归分析模型分析影响COPD急性加重期患者PH发生的因素,绘制受试者工作特征(ROC)曲线分析%CSA＜5、% CSA5~10、SDF-1预测COPD急性加重期患者并发PH的价值。结果 合并PH组的COPD急性发作次数、血二氧化碳分压均高于无PH组,血氧分压、第1秒用力呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)均低于无PH组(P＜0.05)。合并PH组的% CSA 5~10、SDF-1均高于无PH组,%CSA＜5低于无PH组(P＜0.05)。Logistic回归分析结果显示COPD急性发作次数(OR=3.002,95%CI:1.321~6.824)、FEV1/FVC(OR=0.298,95%CI:0.138~0.643)、%CSA＜5(OR=0.263,95%CI:0.095~0.726)、% CSA 5~10(OR=3.014,95%CI:1.721~5.279)、SDF-1(OR=2.867,95%CI:1.072~7.669)是影响COPD急性加重期患者并发PH的独立因素(P＜0.05)。ROC曲线分析结果显示,%CSA ＜5、% CSA 5~10、SDF-1及三者联合预测COPD急性加重期患者发生PH的灵敏度分别为71.43%(95%CI:0.585~0.818)、77.78%(95%CI:0.652~0.869)、66.67%(95%CI:0.536~0.777)、88.89%(95%CI:0.778~0.950),特异度分别为71.43%(95%CI:0.535~0.848)、74.29%(95%CI:0.564~0.869)、65.71%(95%CI:0.477~0.803)、91.43%(95%CI:0.758~0.978),AUC分别为0.708(95%CI:0.604~0.813)、0.722(95%CI:0.613~0.832)、0.701(95%CI:0.583~0.818)、0.892(95%CI:0.829~0.955),联合预测的AUC均高于单独预测(P＜0.05)。 |
| 英文摘要: |
| Objective To explore the value of quantitative parameters of pulmonary small vessels in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) combined with serum levels of stromal cell-derived factor-1 (SDF-1) in predicting pulmonary hypertension (PH). Methods 98 patients with acute exacerbation of COPD who were admitted to the hospital from January 2021 to December 2024 were selected as the research subjects. They were divided into the non-PH group (63 cases) and the PH group (35 cases) based on whether they had PH. Multislice spiral CT was used to measure the cross-sectional area (CSA) of small pulmonary vessels. The ratios of CSA< 5, CSA 5 - 10 to the total CSA of the lungs (denoted as %CSA < 5 and %CSA 5 - 10, respectively) were calculated; the serum SDF-1 level was detected by enzyme-linked immunosorbent assay. The basic data of the two groups and the differences in CSA and SDF-1 were collected and compared. The logistic regression analysis model was used to analyze the factors influencing the occurrence of PH in patients with acute exacerbation of COPD, and the receiver operating characteristic (ROC) curve was drawn to analyze the value of %CSA< 5, %CSA 5-10, and SDF-1 in predicting the occurrence of PH in patients with acute exacerbation of COPD. Results The number of acute COPD attacks and the blood carbon dioxide pressure in the PH group were higher than the non-PH group. The blood oxygen pressure, forced expiratory volume in one second (FEV1), and the ratio of FEV1 to forced vital capacity (FEV1/FVC) in the PH group were lower than the non-PH group (P < 0.05). The percentages of CSA5-10 and SDF-1 in the PH group were higher than those in the non-PH group, while the percentage of CSA< 5 in the PH group was lower than the non-PH group (P < 0.05). The results of the logistic regression analysis showed that the number of acute exacerbations of COPD (OR = 3.002, 95% CI: 1.321 - 6.824), FEV1/FVC (OR = 0.298, 95% CI: 0.138 - 0.643), %CSA< 5 (OR = 0.263, 95% CI: 0.095 - 0.726), %CSA5 - 10 (OR = 3.014, 95% CI: 1.721 - 5.279), and SDF-1 (OR = 2.867, 95% CI: 1.072 - 7.669) were independent factors influencing the occurrence of PH in patients with acute exacerbation of COPD (P < 0.05). The results of ROC curve analysis showed that the sensitivities of %CSA< 5, %CSA 5-10, SDF-1, and their combination in predicting PH in patients with acute exacerbation of COPD were 71.43% (95% CI: 0.585 - 0.818), 77.78% (95% CI: 0.652 - 0.869), 66.67% (95% CI: 0.536 - 0.777), and 88.89% (95% CI: 0.778 - 0.950), the specificities were 71.43% (95% CI: 0.535 - 0.848), 74.29% (95% CI: 0.564 - 0.869), 65.71% (95% CI: 0.477 - 0.803), and 91.43% (95% CI: 0.758 - 0.978), the AUC were 0.708 (95% CI: 0.604 - 0.813), 0.722 (95% CI: 0.613 - 0.832), 0.701 (95% CI: 0.583 - 0.818), and 0.892 (95% CI: 0.829 - 0.955). The AUC of the combined prediction was higher than that of the individual prediction (P< 0.05). Conclusion The quantitative parameters of pulmonary small vessels, such as CSA (% CSA< 5, % CSA5 - 10), and SDF-1 are associated with the occurrence of PH in patients with acute exacerbation of COPD. The combination of these three parameters can improve the predictive efficacy for PH. |
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