合并心力衰竭对慢性阻塞性肺疾病患者血浆氨基酸末端脑钠素前体水平的影响

The change of plasma N-terminal pro-brain natriuretic peptide levels in chronic obstructive pulmonary disease with heart failure

目的:观察慢性阻塞性肺疾病急性发作(AECOPD)期患者,是否合并心脏疾患引起心力衰竭(心衰),及与单纯心脏疾患引起心衰的血浆N-末端脑钠素前体(NT-proBNP)水平变化的规律及临床意义。方法:利用酶联免疫定量分析(ELISA)法测定血浆中NT-proBNP的浓度,其中AECOPD患者39例(合并心脏疾患引起心衰患者12例);单纯心脏疾患引起心衰15例,同时进行动脉血气分析及超声心动图检查。结果:12例合并心衰的AECOPD患者血浆NT-proBNP值明显高于27例未合并者(P<0.001);血浆NT-proBNP值与左心室舒张末期、收缩末期内径及射血分数存在显著相关性(r=0.471,0.502,-0.522;P=0.003,0.002,0.001);血浆NT-proBNP水平诊断左心收缩功能不全的受试者工作特征(ROC)曲线下面积为0.828。结论:测定血浆NT-proBNP水平可能成为临床诊断AECOPD合并心功能不全有意的参考指标。

Objective： To investigate the change of plasma level of N-terminal pro-brain natriuretic peptide （NT-proBNP） in acute-exacerbation chronic obstructive pulmonary disease （AECOPD） and AECOPD with heart failure.Method：The plasma NT-proBNP levels in 39 patients with AECOPD （12 with heart failure） and 15 heart failure patients without AECOPD were determined by enzyme linked immunosorbent assay （ELISA）, and the arterial blood gas analysis and echocardiography were measured simultaneously. Result： NT-pmBNP levels in AECOPD patients with heart failure were higher than those of AECOPD. （P 〈 0.001）. NT-pmBNP levels were significantly correlated with the left ventricular end-diastole and end-systole diameter as well as ejection fraction（ r = 0.471, 0. 502, -0. 522;P = 0.003,0.002,0.001 ）. Conclusion： NT-proBNP determination has a role in the early diagnosis of left heart failure in patients with AECOPD.