| 陈刚,赵松韵,朱珍珍.慢性阻塞性肺疾病急性加重期病人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,2026,30(9):1811-1816. |
| 慢性阻塞性肺疾病急性加重期病人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 |
| Value of quantitative parameters of pulmonary small vessels combined with serum stromal cell-derived factor-1 level in predicting pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease |
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| DOI：10.3969/j.issn.1009-6469.2026.09.021 |
| 中文关键词: 肺疾病，慢性阻塞性 肺小血管 定量参数 基质细胞衍生因子 -1 肺动脉高压 |
| 英文关键词: Pulmonary disease, chronic obstructive Pulmonary small vessels Quantitative parameters Stromal cell-derived fac. tor-1 Pulmonary hypertension |
| 基金项目:海南省卫生健康行业科研项目( 2024A210311) |
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| 中文摘要: |
| 目的探讨慢性阻塞性肺疾病( COPD)急性加重期病人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。方法横断面研究。选取 2021年 1月至 2024年 12月中国人民解放军南部战区海军第二医院收治的 98例 COPD急性加重期病人为研究对象，依据是否合并 PH分为无 PH组( 63例)、合并 PH组( 35例)。以多层螺旋 CT测定肺小血管横截面积( CSA)分别计算 CSA<5 mm2、CSA 5~10 mm2肺小血管 CSA之和与肺总 CSA的比值(记为 % CSA<5、% CSA 5~10)；以酶联免疫吸附分析，检测血清 SDF-1水平。收集并对比两组基本资料及肺小血管 CSA、SDF-1差异。以 logistic回归分析模型分析影响 COPD急性加重期病人 PH发生的因素，绘制受试者操作特征曲线( ROC曲线)分析 % CSA<5、% CSA 5~ 10、SDF-1预测 COPD急性加重期病人并发 PH的价值。结果合并 PH组的 COPD急性发作次数、动脉血二氧化碳分压均高于无 PH组，动脉血氧分压、第 1秒用力呼气容积( FEV1)、一秒率均低于无 PH组( P<0.05)。合并 PH组的 % CSA 5~10［( 0.58±0.09)%比( 0.32±0.06)%］、 SDF-1［( 189.85±26.87)mg/L比( 151.02±22.54)mg/L］均高于无 PH组， % CSA<5［( 0.54±0.11)%比(0.82±0.15)%］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=3.00)、一秒率( OR=0.30)、 % CSA< 5(OR=0.26)、 % CSA 5~10(OR=3.01)、 SDF-1(OR=2.87)是影响 COPD急性加重期病人并发 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急性加重期病人发生 PH的灵敏度分别为 71.43%、77.78%、66.67%、88.89%，特异度分别为 71.43%、74.29%、65.71%、91.43%，AUC分别为 0.71、0.72、0.70、0.89，联合预测的 AUC均高于单独预测( P<0.05)。结论肺小血管定量参数 CSA(% CSA<5、% CSA 5~10)、 SDF-1与 COPD急性加重期病人发生 PH有关，三者联合用于预测 PH可提高预测效能。 |
| 英文摘要: |
| Objective To investigate the value of quantitative parameters of pulmonary small vessels combined with serum stromal cell-derived factor-1 (SDF-1) level in predicting pulmonary hypertension (PH) in patients with acute exacerbation of chronic obstructivepulmonary disease (COPD).Methods This cross-sectional study enrolled 98 patients with acute exacerbation of COPD admitted to theSecond Naval Hospital of the PLA Southern Theater Command from January 2021 to December 2024. They were divided into a non-PH group (63 cases) and a PH group (35 cases) according to the presence of PH. Multislice spiral CT was used to measure the cross-section. al area (CSA) of small pulmonary vessels. The sum of the cross-sectional areas of small pulmonary vessels with CSA <5 mm2 and CSA 5-10 mm2 was calculated, and the ratios of these sums to the total lung CSA (denoted as % CSA<5 and % CSA 5-10, respectively) were determined. Serum SDF-1 level was measured by enzyme-linked immunosorbent assay (ELISA). Baseline characteristics, as well as the pulmonary small vessel CSA parameters and SDF-1 levels, were compared between the two groups. Logistic regression analysis was per.formed to identify factors influencing the occurrence of PH, and receiver operating characteristic curves (ROC curves) were plotted toevaluate the predictive value of % CSA<5, % CSA 5-10, and SDF-1 for PH in patients with acute exacerbation of COPD.Results The number of acute exacerbations of COPD and arterial partial pressure of carbon dioxide (PaCO2) were significantly higher in the PH group than in the non-PH group, whereas arterial partial pressure of oxygen (PaO2), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio were significantly lower in the PH group (P<0.05). The % CSA 5-10 [(0.58±0.09)% vs. (0.32±0.06)%] and SDF-1 [(189.85±26.87) mg/L vs. (151.02±22.54) mg/L] were significantly higher in the PH group, while % CSA<5 [(0.54±0.11)% vs. (0.82± 0.15)% ] was significantly lower (P<0.05). Logistic regression analysis showed that the number of acute exacerbations (OR=3.00), the FEV1/FVC ration (OR=0.30), % CSA<5 (OR=0.26), % CSA 5-10 (OR=3.01), and SDF-1(OR=2.87) were independent risk factors for PH in these patients (P<0.05). ROC curve analysis demonstrated that the sensitivity and specificity of % CSA<5, % CSA 5-10, SDF-1,and their combination for predicting PH were 71.43% and 71.43%, 77.78% and 74.29%, 66.67% and 65.71%, and 88.89% and91.43%, respectively; the area under the curve (AUC) values were 0.71, 0.72, 0.70, and 0.89, respectively. The AUC of the combinedprediction was significantly higher than that of any individual parameter (P<0.05).Conclusions The quantitative parameters of pulmo. nary small vessels, such as CSA (% CSA<5 and % CSA 5-10), and SDF-1 are associated with the development of PH in patients withacute exacerbation of COPD. Combinating these three indicators can improve the predictive performance for PH. |
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