Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease.
Y, Z., D, Z., W, J., & Y, L. (2026). Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease.. Lung. https://doi.org/10.1007/s00408-026-00922-x
Y Z, D Z, W J, Y L. Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease.. Lung. 2026; doi: 10.1007/s00408-026-00922-x
Y Z, D Z, W J, et al. Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease.[J]. Lung. 2026. DOI: 10.1007/s00408-026-00922-x.
@article{y2026,
author = {Zhang Y and Zhang D and Jia W and Li Y},
title = {Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease.},
journal = {Lung},
year = {2026},
doi = {10.1007/s00408-026-00922-x},
note = {PMID: 42611378},
}
TY - JOUR AU - Zhang Y AU - Zhang D AU - Jia W AU - Li Y TI - Clinical Relevance of Serum Inducible and Endothelial Nitric Oxide Synthase Ratio for Pulmonary Hypertension in Acute Exacerbated Chronic Obstructive Pulmonary Disease. T2 - Lung PY - 2026 DO - 10.1007/s00408-026-00922-x AN - PMID:42611378 ER -
BACKGROUND: Pulmonary 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. METHODS: This 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. RESULTS: Compared 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, PaO2, eNOS, and eNOS/iNOS ratio were protective factors. In PH patients, iNOS was positively correlated with pulmonary artery systolic pressure, while eNOS and eNOS/iNOS ratio were negatively correlated. Additional analysis showed that iNOS was negatively correlated with TAPSE/PASP, whereas eNOS and the eNOS/iNOS ratio were positively correlated; the ratio showed the strongest association (r = 0.53, P < 0.001). CONCLUSION: Serum 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.