C型利钠肽在慢性阻塞性肺疾病、慢性肺源性心脏病中的变化及其临床意义

Changes and clinical significance of plasma c-type natriuretic peptide levels in patients with chronic obstructive pulmonary disease and chronic cor pulmonale

目的探讨C型利钠肽(CNP)在慢性阻塞性肺疾病(COPD)、慢性肺源性心脏病(肺心病,CCP)中的作用和临床意义。方法采用放免法检测28例慢性支气管炎急性期并阻塞性肺气肿(A组)、30例肺心病急性期(B1组)和缓解期(B2组),30名健康者对照(C组)血浆中的CNP、肾上腺髓质素(ADM),血清中的血管内皮生长因子(VEGF)采用酶联免疫吸附法(ELISA)测定。结果A、B1、B2组患者中血浆CNP、ADM、血清VEGF水平均高于C组(P<0.01);血浆CNP水平B1组高于B2组(P<0.05),B2组高于A组(P<0.01);血浆ADM水平B1组高于B2组(P<0.01),B2组和A组比较差异无显著性(P>0.05);血清VEGF水平B1组高于B2组和A组(P<0.01),而B2组和A组无显著性差异(P>0.05)。A、B2、B1组中血浆CNP、血清VEGF、血浆ADM水平均呈正相关(分别为r=0.698,P<0.01;r=0.283,P<0.05)。结论血浆CNP水平变化,可以反映肺心病的病情,即CNP水平越高,病情越重。

Objective To study the role and clinical signifwance of plasma c-type natriuretic peptide（CNP） levels in patients with chronic obstructive pulmortary disease（COPD） and chronic cot palmonale （CCP）. Methods CNP and adrenomedullin （ADM） of Plasma samples from 28 patients of chronic bronchitis with obstructive pulmonary emphysema （ Group A）, 30 acute exacerbation （ Group B1 ） and stable （Group B2） of CCP and 30 healthy control（ Group C） were detected by radioimmoassay. Meanwhile, serum levels of vascular endothelial growth factor（VEGF） were tested by ELISA. Resnits Levels of plasma CNP and ADM and serum VEGF in group B1 ,B2 and group A were significantly elevated than that of control group（P 〈0.01）. CNP at acute exacerbation stage in group B1 was higher than that at stable stage in group B2 （ P 〈 0.05 ）, and group B2 higher than group A （ P 〈 0.01 ）. Plasma ADM in group B 1 was significantly higher than that in group B2 and group A（ P 〈 0.01 ）, While between group B2 and group A ,there was no statistic difference （ P 〉 0.05 ）. Serum VEGF in group B 1 was significantly higher than that in group B2 （ P 〈 0.01 ）. While between group B2 and group A, there was no statistic difference （ P 〉 0.05 ）. During the process from A to B2 ,and to B1 ,levels of plasma CNP positively correlated with that of Serum VEGF （ r = 0. 698, P 〈 0.01 ） ; Meanwhile, there was also correlation between CNP and ADM （ r = 0.283, P 〈 0. 05）. Conclusion The increasing of endogenous CNP may be relative to self-regulation. Exogenous CNP may be decrease the pulmonary hypertension and inhibit reconstruction of lung vascular.