摘要目的:随访慢性阻塞性肺疾病（慢阻肺）合并肺动脉高压（PH）患者的临床特征，探讨其与慢阻肺急性加重的关系。方法:前瞻性纳入河南科技大学第一附属医院呼吸科门诊的366例稳定期慢阻肺患者，其中男236例，女130例，年龄50~78（59±9）岁。所有患者均进行3年随访，每年完成肺功能检查、慢阻肺评估测试（CAT）、圣乔治呼吸问卷（SGRQ）、经胸超声心动图、胸部CT及相关实验室生物化学检测。根据静息状态下超声心动图测量的三尖瓣反流峰值流速（TRV）和其他指标评估肺动脉高压（PH）的可能性，用低、中、高可能性表示，以高可能性为PH组，低、中可能性为非PH组。比较2组临床特点。组间比较，正态分布采用 t检验，构成比用 χ2检验，对数据进行Pearson相关分析，采用多因素 logistic 回归和逐步回归进行危险因素分析。 结果:67例（67/366，18.3%）合并PH可能性高，PH组平均肺动脉收缩压（sPAP）为（51.7±6.7）mmHg（1 mmHg=0.133 kPa）。与非PH组相比，PH组年龄（76.0岁比64.0岁）、体重指数 ［（21.4±6.0）比（22.6±7.2）kg/m 2］，脑钠肽［（50.8±9.1）比（36.4±8.1）pg/ml］、3年急性加重次数［（6.1±0.1）比（2.8±0.4）次］、CAT（17.0比10.0分）、SGRQ（48.9比32.1分）和D LCO占预计值% ［（51.9±21.9）% 比（67.0±22.1）%］的差异均有统计学意义（均 P<0.05）。慢阻肺患者D LCO占预计值%与sPAP呈负相关（ r=-0.28， P<0.01）。PH组胸部CT低衰减区（56.1%比34.3%）和肺间质异常比例（30.8%比15.6%）均高于非PH组，差异有统计学意义（均 P<0.01）。LAA%≥30%和肺间质异常是PH的独立危险因素（ β值分别为1.479和1.065， OR值为3.640~5.720，95% CI：1.462~8.571，均 P<0.01）。主肺动脉直径与主动脉直径的比值与sPAP呈负相关（ r=-0.35， P<0.01）。年龄≥75岁、FEV 1占预计值%<50%及合并PH高可能性是慢阻肺急性加重的预测因素（ β值为0.459~1.211， OR值为3.643~5.722，95% CI：1.463~8.904，均 P<0.01）。 结论:超声心动图评估的合并PH高可能性的慢阻肺患者年龄较大，体重指数较低，一般状况更差。PH高可能性和肺气肿密切相关，与慢阻肺急性加重相关。

abstractsObjective:To investigate the relationship between clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) with pulmonary hypertension (PH) and COPD exacerbation over a three-year observation period.Methods:A total of 366 cases of stable COPD patients were enrolled from the Department of Respiratory Medicine of the First Affiliated Hospital of Henan University of Science and Technology. The patients underwent pulmonary function tests(PFT), COPD assessment test (CAT), Saint George′s respiratory questionnaire (SGRQ), transthoracic echocardiogrophy(TTE), chest CT and biochemical detection. The likelihood of PH was evaluated based on the peak tricuspid regurgitation velocity (TRV) measured by echocardiography at rest and other indicators, which were represented by low, medium, and high probability, respectively. Highly probability was defined as PH. The mean values of the groups were compared using a two-tailed unpaired t test for normally distributed variables. Qualitative data were assessed using a χ 2 test. Pearson correlation analysis was performed, and risk factors were analyzed using logistic regression analysis and stepwise regression analysis. P<0.05 was considered to indicate statistical significance. Results:The prevalence of patients with high likelihood of PH was 18.3% ( n=67) in a series of 366 patients with COPD. The median estimated systolic pulmonary artery pressure in patients with PH was (51.7±6.7) mmHg(1mmHg=0.133 kPa). There were differences between patients with high likelihood of PH and those with low to moderate likelihood of PH for the following factors: age (76.0 vs. 64.0), body mass index (BMI) [(21.4±6.0) kg/m 2vs. (22.6±7.2)kg/m 2], brain natriureticpeptide (BNP) [(50.8±9.1) pg/ml vs. (36.4±8.1) pg/ml], toral number of acute exacerbation in three-year [(6.1±0.1) times vs. (2.8±0.4) times], CAT (17.0 vs. 10.0), SGRQ (48.9 vs. 32.1), carbon monoxide diffusion percentage of predicted value (D LCO%) [(51.9±21.9)% vs. (67.0±22.1)%]; all the differences being statistically significant(mean P<0.05).There was a negative correlation between D LCO% and SPAP ( r=-0.28, P<0.01).In patients with high likelihood of PH, the percentage of low attenuation area (LAA%) and interstitial abnormalities in chest CT were higher than those in patients with low to moderate likelihood of PH (56.1% vs. 34.3% and 30.8% vs. 15.6%, mean P<0.05).LAA% ≥ 30% and pulmonary interstitial abnormalities were independent risk factors for pH [beta value were 1.479, 1.065, OR value was (3.640-5.720), 95% CI (1.462-8.571), mean P<0.01]. The ratio of main pulmonary diameter to aortic artery diameter was significantly correlated with estimated systolic pulmonary artery pressure( r=-0.35, P<0.01).Age ≥75 years, FEV 1%predicted value<50% and the presence of PH increased the likelihood of exacerbations of COPD over three years[beta value (0.459-1.211), OR value (3.643-5.722), 95% CI (1.463-8.904), mean P<0.01]. Conclusions:COPD patients with high likelihood of PH assessed by echocardiography were older, had a lower BMI, and presented with a worse health status compared to those with low to moderate likelihood of PH. The presence of PH assessed by echocardiography was related to future COPD exacerbations in COPD patients, and emphysema was closely related to PH assessed by echocardiography.