ArticleLung2026
Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease.
Article in Lung, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPulmonary hypertension (PH) is a common complication of acute exacerbated chronic obstructive pulmonary disease (AECOPD) and is associated with poor prognosis. Nitric oxide synthase (NOS) imbalance may contribute to pulmonary vascular dysfunction, but the clinical value of serum inducible NOS (iNOS), endothelial NOS (eNOS), and the eNOS/iNOS ratio in AECOPD with PH remains unclear.
methodsThis study included 260 hospitalized AECOPD patients, including 122 without PH and 138 with PH diagnosed by Doppler echocardiography. Clinical characteristics, pulmonary function, and arterial blood gas parameters were collected. Serum iNOS and eNOS levels were measured by ELISA, and the eNOS/iNOS ratio was calculated. The TAPSE/PASP ratio was calculated in patients with PH as an index of right ventricular-pulmonary arterial (RV-PA) coupling. ROC analysis, multivariate logistic regression, and correlation analysis were performed.
resultsCompared with patients without PH, those with PH had significantly higher serum iNOS levels and significantly lower eNOS levels and eNOS/iNOS ratio (all P < 0.001). Similar trends were observed in patients with GOLD grade III-IV versus I-II. The eNOS/iNOS ratio showed the best diagnostic performance for PH, with an AUC of 0.86, sensitivity of 83.33%, and specificity of 74.59%. Multivariate logistic regression identified smoking, GOLD grade III-IV, hypertension, and elevated iNOS as independent risk factors, whereas higher FEV1%pred, PaO
conclusionSerum NOS imbalance is closely associated with PH in AECOPD. Its association with TAPSE/PASP further suggests relevance to impaired RV-PA coupling. The eNOS/iNOS ratio may serve as a promising noninvasive biomarker for identifying COPD-related PH.
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