低氧血症对血浆氨基末端B型利钠肽的影响

Effects of hypoxemia on plasma N-terminal pro-B-type natriuretic peptide levels

目的探讨血浆氨基末端B型利钠肽前体（ NT-proB-NP）与低氧血症之间的关系。方法回顾性分析453例同时行NT-proBNP、血气分析及超声心动图检查的住院患者临床资料,根据氧合指数分为低氧血症组和无低氧血症组,比较两组患者血浆NT-proBNP浓度变化,并分别比较在左心室收缩功能不全、肺动脉高压、左心室收缩功能不全合并肺动脉高压及心功能正常情况下两组血浆NT-proBNP浓度的变化。将心功能正常条件下的低氧血症组患者根据氧合指数分为Ⅰ（301~400 mmHg ）、Ⅱ（201~300 mmHg ）、Ⅲ（≤200 mmHg）3个亚组,分析低氧程度与血浆NT-proBNP浓度的关系。结果[1]低氧血症组患者血浆NT-proBNP浓度高于无低氧血症组（ P〈0.01）。在左心室收缩功能不全、肺动脉高压、心功能正常3种情况下低氧血症组患者NT-proBNP浓度均高于无低氧血症组（P〈0.05）。于在心功能正常条件下的低氧血症组中,Ⅲ组患者的血浆NT-proBNP水平高于Ⅰ和Ⅱ组（P〈0.05）。[3]血浆NT-proBNP浓度与氧合指数呈负相关；与PaCO2不相关。结论低氧血症可能是血浆NT-proBNP浓度升高的一个独立影响因素,并且与缺氧程度呈正相关。

Objective To explore the relationship between NT-proBNP and hypoxemia. Methods 453 patients who accepted examinations of plasma NT-proBNP,blood gas analysis and echocardiography were retrospectively in-vestigated and were divided into hypoxic and normoxic groups according to oxygeneration index. The concentrations of serum NT-proBNP were compared in the two groups,and also on situations including left ventricular systolic dys-function,pulmonary artery hypertension,left ventricular systolic dysfunction with pulmonary artery hypertension and normal cardiac function. Then the hypoxic patients with normal cardiac function were classified into three sub-groups：Ⅰ（ oxygeneration index：301~400 mmHg） ,II（ oxygeneration index：201~300 mmHg） ,Ⅲ（ oxygeneration index≤200 mmHg） to detect the relationship between NT-proBNP and the degree of hypoxia. Results ① In hy-poxic group,the plasma NT-proBNP levels were higher than patients in normoxic group（P〈0.01）. NT-proBNP lev-els were also higher in hypoxic group in patients with left ventricular systolic dysfunction or pulmonary artery hyper-tension or normal cardiac function（P〈0.05）.②NT-proBNP levels were higher in sub-groupⅢthanⅠandII（P〈0.05） in hypoxic patients without heart dysfunction.③ The correlation analysis suggested that NT-proBNP was negatively correlated with oxygeneration index and there was no correlation between NT-proBNP and PaCO2 . Con-clusion Hypoxemia may be an independent factor which influences plasma NT-proBNP levels. NT-proBNP posi-tively correlates with the degree of hypoxia.