D.二聚体xNT-proBNP对慢性阻塞性肺疾病并肺动脉高压的诊断价值江帆，陈浩(德阳市人民医院，四川德阳618000)摘要：目的分析血浆D-二聚体(DD)及N端脑钠肽前体(NT-proBNP)对慢性阻塞性肺疾病(COPD)并肺动脉高压(PH)的诊断价值。方法选择自2013年1月至2016年1月我院呼吸内科住院并确诊为COPD的500名患者，根据有无合并PH分为PH组(n=236)和作PH组(n=264),并对COPD并PH的相关危险因素进行多因索logistic回归分析，利用ROC曲线分析相关指标的诊断价值。结果①单因素分析示，PH组和非PH组两组间1)1)(/=9.912,P<0.05).NT-proBNP(/=5.592,P<0.05)5LDII(r=7.592,P<0.05).HC03"(r=6.47l,P<0.05).P02(«=5.46i,P<0.05).PC02(/=6.6l8,/><0.05)、年龄>65岁(丁=10.307,P<0.05)、慢性心功能不全(丁=8.307,P<0.05)差异有统计学意义；②多因素Logistic回归分析示,DD、NT-proB、P、HC(V、慢性心功能不全是COPD并PH的独立危险因素(P<0.05)；③ROC曲线示，DD曲线下面积为0.830,最佳阈值为2.18mg/L,灵敏度为0.816,特异性为0.712；NT-proBNP曲线下面积为0.794,最佳阈值为3225ng/L,灵敏度为。.820,特异性为0.782。结论联合DD及NT-proBNP水平对CQPD并PH具.有较高的诊断价值°关键词:慢性阻塞性肺疾病；肺动脉高压；D-二聚体；、•端脑钠肽前体；诊断价值TheDiagnosticValueofDD,NT-proBNPtoChronicObstructivePulmonaryDiseasewithSecondaryPulmonaryHypertensionJIANGFan,CHENHao(People*sHospitalofDeyang,Dcyang618000,China)Abstract：ObjectiveToinvestigatethediagnosticvalueofD-dimer(DD),NT-proBNPtoChronicobstructivepulmonarydisease(COPD)withsecondarypulmonaryhypertension(PH).Methods500casesofCOPDenrolledtotheRespiratorydepartmentofourhospitalfromJanuary2013toJanuary2016wereselected.Patientsweredividedintotwogroups:PHgroup(n=236)andnon-PHgroup(n=264).Amulti-factorLogisticregressionwasperformedtoanalyzetheriskfactorsassociatedwiththeincidenceofCOPDwithsecondaryPH,andthediagnosticvaluewasverifiedontheriskfactorsbyReceiveroperatingcharacteristic(ROC)curve.Results①Univariateanalysisshowedthatwhencomparingtwogroups:DD(t=9.912,P<0.05),NT-proBNP(z=5.592,P<0.05),LDH(f=7.592,P<0.05),HCO3_(/=6.471,P<0.05),P02(r=5.46HP<0.05),PCO2(r=6.618,P<0.05),age>65years(^2=10.307,P<0.05),chronicheartfailure(p=8.307,P<0.05).②Multi-factorLogisticregressionindicatedthatDD,NT-proBNP,HCO3-,chronicheartfailureweretheindependentriskfactorsfortheonsetofPH(P<0.05).③ROCcurveanalysisrevealedthattheoptimalcutoffofDDtodiagnoseCOPDwithPHis2.18mg/L(AUC=0.830,sensitivity0.816,specificity0.712),andtheoptimalcutoffofNT-proBNPtopredictthatis3225ng/L(AUC=0.794,sensitivity0.820,specificity0.782).ConclusionThetherapyofDDcombinedwithNT-proBNPhaveahigherdiagnosticvalueinchronicobstructivepulmonarydiseasewithsecondarypulmonaryhypertension.Keywords：Chronicobstructivepulmonarydisease；Pulmonaryhypertension；D-dimer；NT-proBNP；DiagnosticvalueDOI：10.11748/bjmy.issn.1006-1703.2017.08.010收稿日期：2017-04-19；修回日期：2017-05-05慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)是一种以呼吸道气流完全不可逆受限为主的慢性呼吸系统疾病，且呈进展性发展，病程中可以出现肺动脉高压甚至慢性肺源性心脏病。预计到2020年COPD将成为疾病致死率的第3位L肺动脉高压(pulmonaryhypertension,PH)常继发于COPD,病程可进展至慢性肺源性心脏病⑵。Smith等3研究表明合并PH是影响COPD预后的独立危险因素。且延长住院时间及增加了患者死亡率⑷。Slusser等⑸依据WHO对诊断为第一类PH的患者进行统计研究显示,5年生存率为47.9%o故临床上早期诊断及早期治疗COPD并PH显得尤为重要。本研究旨在观察COPD并PH的相关危险因素，并分析血清D-二聚体(DD)及N端脑钠肽前体(NT-proBNP)水平对COPD并PH的诊断价值。材料和方法1一般资...