Objective      To investigate the relationship of smoking and systemic inflammatory response with pulmonary hypertension (PH) in the patients with chronic obstructive pulmonary disease (COPD).       Methods      A total of 111 COPD patients with PH admitted in our department from April 2013 to March 2015 were consecutively recruited in this study

and another 110 age- and sex-matched COPD patients without PH served as control group. The clinical data of these patients including age

sex

smoking history

erythrocyte sedimentation rate (ESR)

white blood cell count (WBC)

neutral granular cell/lymphocyte ratio (NLR)

serum C-reactive protein (CRP)

interleukin-6 (IL-6)

tumor necrosis factor alpha (TNF-α)

fibrinogen

procalcitonin (PCT)

arterial blood gas

chest CT and Doppler echocardiography results were recorded and compared between the 2 groups.       Results      Smoking index and serum levels of CRP

IL-6 and TNF-α were significantly higher in the COPD patients complicated with PH than those without PH

and were positively correlated with pulmonary arterial systolic pressure (r=0.271

0.181

0.270

0.208

P0.05). Multiple logistic regression analysis showed that smoking

CRP

IL-6 and TNF-α were independent risk factors for pulmonary hypertension (OR= 6.185

6.740

3.434

2.700

P0.05).       Conclusion      Elevated smoking index and higher serum levels of CRP

IL-6 and TNF-α are positively correlated with increase of PH in COPD patients. Our results suggest tobacco smoking and systemic inflammation are closely associated with the development of PH in COPD patients.