慢性阻塞性肺疾病患者不同状态下血浆B型钠尿肽水平的变化及其临床意义

Clinical significance and changes of plasma brain natriuretic peptide level in patients with chronic obstructive pul monary disease under different conditions

目的探讨慢性阻塞性肺疾病(COPD)患者不同状态下血浆B型钠尿肽(BNP)水平的变化及其临床意义。方法回顾性分析急性加重就诊的72例COPD住院患者的临床资料,按诊断分为四组:单纯COPD组、COPD+肺心病代偿期组、COPD+肺心病心力衰竭组和COPD+冠心病心力衰竭组,比较四组患者血浆BNP水平的差异,并分析其影响因素。结果与单纯COPD组比较,其余三组患者的血浆BNP水平均明显增高,差异均有统计学意义(t分别=2.03、9.69、8.45,P均<0.05);与COPD+肺心病代偿期组比较,COPD+肺心病心力衰竭组和COPD+冠心病心力衰竭组的血浆BNP水平增高,差异均有统计学意义(t分别=7.10、6.09,P均<0.05);COPD+肺心病心力衰竭组和COPD+冠心病心力衰竭组的血浆BNP水平比较,差异无统计学意义(t=0.69,P>0.05)。相关分析结果显示:血浆BNP水平与动脉血二氧化碳分压(PaCO_2)、肺动脉收缩压和右心室前后径呈正相关(r分别=0.62、0.76、0.69,P均<0.05),与动脉血氧分压(PaO_2)、第一秒用力呼气容积/用力肺活量(FEV_1/FVC)、FEV_1占预计值%呈负相关(r分别=-0.51、-0.27、-0.28,P均<0.05)。多元逐步回归分析显示:肺动脉收缩压对血浆BNP水平的影响最大(b′=0.37,P<0.05)。结论急性加重的COPD患者不同状态下的血浆BNP水平变化不尽相同,血浆BNP水平的测定对于COPD合并心力衰竭的诊断具有重要意义;COPD+肺心病心力衰竭和COPD+冠心病心力衰竭二者的血浆BNP水平的差异可能并不明显。

Objective To investigate the clinical significance and changes of plasma brain natriuretic peptide （BNP） level in patients with chronic obstructive pulmonary disease（COPD） under different conditions. Methods The clinical da-ta of 72 cases COPD patients who were exacerbated in acute were analyzed retrospectively. According to the diagnosis, the patients were divided into four groups：simple COPD group, COPD combined with pulmonary heart disease in compensated stage group, COPD combined with pulmonary heart disease in heart failure group, and COPD combined with coronary heart disease in heart failure group. The differences of BNP levels among the four groups were compared and their influ-ence factors were analyzed. Results Compared with simple COPD group, the levels of plasma BNP of other three groups were significantly increased（t=2.03, 9.69,8.45,P〈0.05）. Compared with COPD combined with pulmonary heart disease in compensatory stage group, the BNP levels in COPD combined with pulmonary heart disease in heart failure group and COPD combined with coronary heart disease in heart failure group were significantly increased （t=7.10,6.09,P〈0.05）. There was no significant differences of BNP level between COPD combined with pulmonary heart disease in heart failure group and COPD combined with coronary heart disease in heart failure group （t=0.69,P〉0.05）. The correlation analysis showed that plasma BNP levels was positive related to PaCO2, pulmonary artery systolic pressure and right ventricular di-ameter （r=0.62,0.76,0.69,P〈0.05）while negative related to PaO2, FEV1/FVC, FEV1%（r=-0.51,-0.27,-0.28,P〈0.05）. Multiple stepwise regression analysis showed that the pulmonary artery systolic pressure greatest influenced on BNP level（b′=0.37,P〈0.05）. Conclusions The changes of plasma BNP levels in different status of COPD patients who were exacerbated in acute are not similar. The determination of plasma BNP level has impor-tant significance in diagnosis of COPD combined with heart failure. There may be no obvious difference in BNP levels be-tween COPD combined with pulmonary heart disease and COPD combined with coronary heart disease.