肺部疾患血浆氨基酸末端脑钠素前体水平的预测价值分析

N-terminal pro-B-type natriuretic peptide： a prognostic parameter in lung disease

目的通过观察肺部疾病及其合并左心功能不全患者血浆氨基酸末端脑钠素前体（N—terminal pro—B-type natriuretic peptide，NT—proBNP）水平的变化，及其对疾病预后的预测，探讨其变化规律及临床意义。方法利用酶联免疫吸附试验法测定81例肺部疾病患者血浆中NT—proBNP的浓度，其中未合并左心功能不全者68例，合并左心功能不全者13例；对照组（15例）为单纯心脏疾病引起左心功能不全者。同时进行动脉血气分析、静态肺功能以及超声心动图检查。结果在肺部疾病患者中，合并左心功能不全者血浆NT—proBNP水平明显高于未合并左心功能不全者（P=0．01）；而与对照组相比差异无统计学意义。血浆NT—proBNP水平与右心室前后径、右心室流出道、估测肺动脉压力及左室舒张、收缩末期内径呈正相关；与射血分数呈显著负相关。NT—proBNP对于是否合并左心室功能不全的ROC曲线下面积为0．720；用于诊断肺部疾病合并肺动脉高压的ROC曲线下面积为0．719。采用多因素非条件Logistic回归发现，血浆NT—proBNP水平是影响肺部疾病患者住院期间病死率的主要因素。结论测定血浆NT—proBNP水平可以作为预测肺部疾病患者是否合并左心功能不全及预后的重要指标。

Objective To evaluate N-terminal pro-B-type natriuretic peptide（NT-proBNP） level as a parameter for the presence of left heart failure and mortality of hospital stay in patients with lung disease. Methods Plasma NT-proBNP level was measured in patients with lung disease （68 cases without left heart failure, 13 cases with left heart failure） and 15 patients with left heart failure because of eardiogenic reasons. Arterial blood gas analysis, echocardiography and pulmonary function testing were measured. Results Plasma level of NT-proBNP was significantly elevated in patients with left heart failure compared with that of patients without left heart failure （P = 0.01）. NT-proBNP level correlated with pulmonary arterial pressure,internal diameter of outflow tract and anteroposterior diameter of right ventricle, internal diameter of end diastole and end-systole of left ventricle and ejection fraction. Roe analysis was done to assess the discriminatory ability of NT-proBNP for left heart failure and pulmonary hypertension in patients with lung disease. The area under the curve was respectively 0. 720 and 0. 719. NT-proBNP level served as a risk factor of death in duration of hospital stay by multivariate analysis. Conclusions NT-proBNP is a prognostic parameter in lung disease.