【摘要】 目的探讨红细胞分布宽度(red blood cell distribution width,RDW)和血清胱抑素C(serum cystatin C,Cys-C)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)继发肺动脉高压的联合诊断价值,为COPD继发肺动脉高压的早期诊断提供新的诊断指标及诊断方法。方法选取COPD患者122例,通过多普勒心动超声测量肺动脉压值(其中以肺动脉收缩压>40 mmHg为肺动脉高压),将患者分为肺动脉压正常组与肺动脉压升高组,抽取患者静脉血3～5 mL,乙二胺四乙酸(ethylene diamine tetraacetic acid,EDTA)抗凝,分别检测RDW和Cys-C值,绘制RDW和Cys-C诊断COPD继发肺动脉高压的受试者工作曲线(receiver operator characteristic curve,ROC曲线),计算诊断价值,然后使用Logistics回归分析预测RDW和Cys-C诊断COPD继发肺动脉高压的概率。最后绘制RDW和Cys-C联合诊断COPD继发肺动脉高压的ROC曲线,并计算其诊断价值。结果 RDW和Cys-C单独诊断COPD继发肺动脉高压的曲线下面积(area under curve,AUC)分别为0.844和0.849。约登指数分别为0.618和0.597,敏感度分别为75.9%和84.1%,特异度分别为85.9%和75.6%,RDW和Cys-C联合诊断COPD继发肺动脉高压的AUC为0.926,约登指数为0.781,敏感度和特异度分别为90.9%和87.2%。结论 RDW和Cys-C对于诊断COPD继发肺动脉高压具有一定的价值,两者联合可提高诊断COPD继发肺动脉高压的敏感度和特异度,降低误诊率及漏诊率。更多还原

【Abstract】 Objective To explore the combined diagnostic value of red blood cell distribution width(RDW) and serum cystatin C(Cys-C) for pulmonary hypertension secondary to chronic obstructive pulmonary disease(COPD), and to provide new diagnostic indexes and methods for the early diagnosis of COPD secondary pulmonary hypertension. Methods A total of 122 patients with COPD were selected to measure the pulmonary arterial pressure by Doppler echocardiography(the systolic pressure of pulmonary artery>40 mmHg was pulmonary arterial pressure). The patients were divided into two groups: the normal group and the increased group. Taking 3-5 mL of venous blood from patients, ethylene diamine tetraacetic acid anticoagulation, RDW and Cys-C values were detected respectively, receiver operator characteristic curve(ROC curve) of RDW and Cys-C in diagnosing COPD secondary pulmonary hypertension was drawn, diagnostic value was calculated, and then the probability of RDW and Cys-C in diagnosing COPD secondary pulmonary hypertension was predicted by logistic regression. Finally, the ROC curve of RDW and Cys-C in COPD secondary pulmonary hypertension was drawn, and its diagnostic value was calculated. Results The AUC of RDW and Cys-C was 0.844 and 0.849 respectively. The sensitivity was 75.9% and 84.1% respectively, the specificity was 85.9% and 75.6% respectively, the AUC of RDW and Cys-C was 0.926, the sensitivity and specificity were 90.9% and 87.2%, respectively. Conclusion RDW and Cys-C have certain value in the diagnosis of COPD secondary pulmonary hypertension. The combination of RDW and Cys-C can improve the sensitivity and specificity of COPD secondary pulmonary hypertension diagnosis, and reduce the misdiagnosis rate and missed diagnosis rate.更多还原