摘要
目的探讨血清氨基末端脑纳肤前体(amino-terminalpro-brain natriuretic peptide, NT Pro BNP)、C反应蛋白(C-reaction protein, CRP)及D二聚体(D-Dimer)水平在慢性阻塞性肺疾病急性加 重期(AECOPD)合并肺功脉高压(PH)患者中的临床意义及相关性。方法入选126例AECOPD患者,超声心动图测得肺功脉收缩压(PASP)值,根据PASP分为3组:对照组?40mmHgH5例、轻度 PH组(40-60 mmHgH7例和中重度PH组(〉60 mmHg)34例。对所有人选患者进行血清NT-Pro BNP、CRP、D-Dimer水平和动脉血气分析检测。结果 AECOPD合并中重度PH组患者NT-Pro BNP [0711.15±437.05) ng/L],PCO2 [(47. 24±8.60) mmHg]、CRP[(25.53±1. 73) mg/L]及D-Dimer [(648.88士618.37)μgiL]水平高于对照组[NT-Pro BNP: (221. 78 ± 63. 62) ng/L; PCO2: (40.04± 6.83) mmHg;CRP: (11.51±2.00) mg/L;D-Dimer:(302. 58±233. 44)同/口,差异均具有统计学意义 (t = -4.005, -3.880,-3.094, -4.073; P值均〈0.05) ;而PO,[(59.43±16. 49) mmHg]低于对照组 [(71.28±15.16)mmHg] ,差异具有统计学意义(t=3.276;P〈0.0日。AECOPD合并中重度PH组患者NT-ProBNP[O 711. 15士437.05) ng/L丁和PCO2[(47. 24±8. 60) mmHg]水平高于轻度PH组 [(NT-Pro BNP:(583. 77士213.98) ng/L;PCO2 :(40. 85±8. 96) mmHg],差异均具有统计学意义( t = -3.069,-3.442; P值均〈 O. 05);而PO, [(59.43土16.49) mmHgJ低于轻度PH组[C66.81± 16.22) mmHgJ,差异具有统计学意义(t = 2. 061; P 〈0.05) 0 AECOPD合并轻度PH组患者CRP [(17.55±4.17) mg/L]及D-Dimer [( 501. 61 ± 218.71)阅/L]水平高于对照组[CRP: (11.51 ± 2.00) mg/L;D-Dimer: (302.58土233.44)μg/口,差异均具有统计学意义( t = -1.452,-2.551; P值 均〈0.0日。NT-ProBNP与PASP、PCO,均呈正相关(r =0. 346, t =4.11; r =0. 336, t =3.97; P值 均〈0.0日。PCO2、CRP、D-Dimer与PASP均呈正相关(r=0. 389, t =4. 70; r =0. 245, t =2. 81; r = 0.349, t =4.15; P值均〈0.05) ;PO2与PASP呈负相关(γ=-0.262, t =-3. 02, P〈0. 0日。结论 血清NT-ProBNP、CRP及D-Dimer水平与PASP密切相关,可以作为AECOPD患者判断PH严重程度的 指标。
Objective To explore the clinical significance and correlation of serum amino terminal pro-brain natriuretic peptide (NT-Pro BNP) ,C-reaction protein (CRP) and the D-Dimer levels in patients of the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with pulmonary hypertension( PH). Methods One hundred and twenty six patients with AECOPD were measured pulmonary artery systolic pressure (P ASP) by echocardiography. They were divided into 3 groups according to PASP:control group ?40 mrn Hg ) 45 cases, mild PH group (40-60 mrn Hg) 47 cases and mederate-severe PH group (〉60 mrn Hg ) 34 cases. Serum NT-Pro BNP,CRP,D-Dimer levels and arterial blood gas analysis were detected from all the selected patients. Results Serum NT-Pro BNP,PCO, ,CRP and D-Dimer in AECOPD with rnederate-severe PH group [NT-Pro BNP: (l 711. 15 ± 437.05) ng/L; PCO2 (47. 24± 8. 60) mrn Hg , CRP: (25.53 ± 1. 73) mgv/L, D-Dimer: (648.88 ± 618. 37) μg/L] were significantly higher than the control ones [NT-Pro BNP: (221. 78 ± 63.62) ng/L, PCO,: (40.04 ± 6.83) mmHg,CRP:C11. 51±2. 00) mg/L,D-Dimer: (302. 58±233. 44) μg/L] ( t = -4. 005, -3. 880, -3.094,-4.073, P〈0.05),while PO, [arterial partial pressure of oxygen:(59.43±16.49) mrn Hg ] were significantly lower than the control ones (71. 28±15. 16) mmHg (t = 3. 276, P 〈0.05). Serum NT-Pro BNP, PCO, in AECOPD with rnederate-severe PH group [NT-Pro BNP: (1711.15 ± 437.05) ng/L,PCO2 (47. 24±8. 60) mmHg] ,were significantly higher than the mild PH ones [NT-Pro BNP: (583. 77±213. 98) ng/L,PCO2 (40. 85±8. 96) rnm Hg j/ t = -3.069, -3. 442, P 〈0. 05), while PO2 (59.43 ± 16.49) ] mmHg were significantly lower than the mild PH group ones (66.81 ± 16.22) mrn Hg (t =2. 061, P〈0. 05). Serum CRP and the D-Dimer levels in mild PH group [CRP:(17. 55± 4.17) mg/L,D-Dimer:(501. 61±218. 71) μg/L] were significantly higher than the control ones [CRP: (11. 51±2. 00) mg/L;D-Dimer: (302. 58±233. 44) μg/L] ( t = -1. 452, -2. 551, P 〈 0.05). NT-Pro BNP was observered a significant positive linear relationship between PASP ( r =0.346, t =4. 11, P 〈0. 01) and PCO,( r =0. 336, t =3.97, P 〈0. 01). We also found that PCO, ,CRP,D-Dimer levels have a significant positive linear relationship between PASP ( r = 0. 389, t = 4.70, r = 0. 245, t = 2.81, r = 0.349, t =4. 15, P 〈0. 05) ,while PO2 was negatively correlated with PASP ( r = -0.262, t = -3.02, P 〈 0.05). Conclusions Serum NT-Pro BNP,CRP and D-Dimer levels are closely related to the PASP, and can be used as indicators to judge the severity of PH in of AECOPD patients.
出处
《国际呼吸杂志》
2014年第5期341-346,共6页
International Journal of Respiration
关键词
慢性阻塞性肺疾病
肺动脉高压
氨基末端脑钠肽前体
C反应蛋白
D二聚体
Chronic obstructive pulmonary disease
Pulmonary hypertension
N-terminal pro-brainnatriuretic peptide
C-reaction protein
D-Dimer