血脑钠肽在慢性阻塞性肺病并肺动脉高压中的临床意义

The clinical significance of brain natriuretic peptides in chronic obstructive pulmonary disease combined with pulmonary hypertension

目的 探讨血浆脑钠肽（BNP）水平在慢性阻塞性肺病急性加重期（AECOPD）合并肺动脉高压（PH）患者中的临床意义.方法 入选80例AECOPD患者,依据超声心动图测得肺动脉收缩压（PASP）值分为3组：正常肺动脉压组19例、轻度PH组37例和中重度PH组24例.对所有研究对象行血浆BNP水平、动脉血氧分压（PaO2）、超敏C反应蛋白（HsCRP）、收缩末期右室,左室内径之比（RVDs/LVDs）等检测.结果 轻度及中重度肺动脉高压组PASP（轻度：44.59±3.27mmHg;中重度：67.46±12.44mmHg）、HsCRP（轻度：8.87±1.20mg/L;中重度：12.06±2.01mg/L）、BNP值（轻度：142.37±27.72pg/mL;中重度：191.12±45.82pg/mL）、RVDs/LVDs（轻度：0.64±0.13;中重度：0.74±0.12）均高于正常肺动脉压组（PASP：25.84±2.27mmHg;HsCRP：2.14±0.81mg/L;BNP：54.54±11.58pg/mL;RVDs/LVDs：0.51±0.14）（P〈0.05）,而PaO2（轻度：63.67±9.58mmHg;中重度：56.62±8.27mmHg）则低于正常肺动脉雁组（88.05±8.13mmHg）（P〈0.05）,两组相比也具有统计学意义（P〈0.05）.3组之间左心室射血分数（LVEF）比较差异无统计学意义（P〉0.05）.PASP与BNP和HsCRP均呈正相关（r=0.795,r=0.852,P〈0.01）,BNP与Pa02呈负相关（r=-0.670,P〈0.01）.结论 AECOPD发生发展过程中,肺动脉压力、Hs-CRP、RVDs/LVDs等渐进性增高,同时也伴随着血浆BNP水平相应升高,故血浆BNP水平与AECOPD合并PH患者病情严重程度成呈相关,可以作为判断病情变化的指标之一.

Objective To study the clinical significance of brain natriuretic peptides （BNP） in acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combined with pulmonary arterial hypertension （PH）. Methods 80 clinical patients with AECOPD were chosen. According to the value of pulmonary artery systolic pressure （PASP） which was detected by using echocardiography, 80 patients were divided into three groups： normal group （n= t9）, mild PH group （n=37） and moderate plus severe PH groups （n=24）. The plasma BNP, arterial partial pressure of oxygen （PaO2）, high sensitivity C-reactive protein （HsCRP）, right ventricular and left ventricular end-systolic diameter ratio （RVDs/ LVDs） of all subjects were detected. Results The PASP （ mild： 44.59 ± 3.27 mmHg; moderate plus severe： 67.46± 12.44 mmHg）, HsCRP （mild： 8.87±1.20 mg/L; moderate plus severe： 12.06±2.01 mg/L）, BNP （mild： 142.37±27.72 pg/mL; moderate plus severe： 191.12±45.82 pg/mL） and RVDs/LVDs （mild： 0.64±0.13; moderate plus severe： 0.74±0.12 ） in two PH groups were higher than those in normal group （ PASP： 25.84 ±2.27 mmHg; HsCRP： 2.14±0.81 mg/L; BNP： 54.54±11.58pg/mL; RVDs/LVDs： 0.51±0.14）（P〈0.05）, while the PaO2 （ mild： 63.67d：9.58mmHg; moderate plus severe： 56.62±8.27 mmHg ） was lower than that in control group （ 88.05±8.13 mmHg ） （P〈0.05）. The two PH groups were also statistically significant （P〈 0.05）. But the left vemricular ejection fraction （LVEF） in all groups has no differences （P 〈 0.05）. The levels of PASP were positively correlated with the levels of the plasma BNP and HsCRP （r=0.795, r=0.852, respectively, P〈0.01）. The levels of plasma BNP were inversely correlated with the levels of PaO2 （r=-0.670, P〈0.01）. Conclusions In the process of AECOPD development the PASP, HsCRP, RVDs/LVDs and the plasma BNP increase simultaneously. The plasma BNP is in positive correlation with the severity of AECOPD combined with PH, and can be used as one of the indicators to determine changes in the disease.