慢性阻塞性肺疾病急性加重期合并心力衰竭患者N端脑钠肽前体及降钙素原检测

Detection of N-terminal brain natriuretic peptide and procalcitonin in patients with acute exacerbation of chronic obstructive pulmonary disease and heart failure

目的探讨N端脑钠肽前体(NT-proBNP)与降钙素原(PCT)水平在慢性阻塞性肺疾病急性加重期(AECOPD)合并心力衰竭患者血清中的变化及临床意义。方法选择慢性阻塞性肺疾病(COPD)缓解期患者作为对照组(n=40),AECOPD合并心力衰竭患者作为观察组(n=60),观察组患者根据心功能不全程度分为纽约心脏病协会(NYHA)心功能Ⅱ级(n=20),NYHA心功能Ⅲ级(n=20),NYHA心功能Ⅳ级(n=20),检测对照组患者NT-proBNP与PCT水平及观察组患者治疗前后NT-proBNP与PCT水平。结果观察组患者治疗前的NTproBNP与PCT水平(4 987±2 618)ng/L,(0.592±0.490)μg/L均显著高于对照组(408±171)ng/L,(0.097±0.118)μg/L(P<0.05)。观察组的3个亚组间NT-proBNP水平(2 547±533)ng/L、(4 430±693)ng/L、(7 982±2 117)ng/L与PCT水平(0.204±0.097)μg/L、(0.439±0.152)μg/L、(1.132±0.471)μg/L差异有统计学意义(P<0.05),且NT-proBNP与PCT水平随心力衰竭严重程度的加重而升高,3个亚组患者治疗后NT-proBNP(494±82)ng/L、(842±299)ng/L、(1 392±422)ng/L及PCT(0.068±0.295)μg/L、(0.097±0.035)μg/L、(0.170±0.059)μg/L的水平均明显低于治疗前水平(P<0.05)。结论 NT-proBNP与PCT是AECOPD合并心力衰竭患者病情严重程度和治疗效果的评价指标。

Objective To explore the changes and the clinical significance of N-terminal brain natriuretic peptide （NT-proBNP） and procalcitonin（PCT） in the serum of patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and heart failure. Methods The patients with chronic obstructive pulmonary disease （COPD） in remission served as control group （n = 40）, the patients of AECOPD with heart failure served as the observation group （ n = 60）, who were subdivided into New York Heart Association（NYHA） lI grade （ n = 20）, NYHA l]] grade （ n =20） ,NYHA IV grade （ n =20） according to cardiac insufficiency degree level. The levels of NT- proBNP and PCT were detected in patients of control group and observation group before and after treatment. Results NT-proBNP and PCT levels of observation group before treatment（4 987±2 618） ng/L, （0. 592±0. 490） μg/L were significantly higher than those of control group（408 ± 171） ng/L, （0. 097 ± 0. 118） μg/L（ P 〈0. 05）. NT-proBNP levels（2 547±533） ng/L,（4 430±693） ng/L,（7 982±2 117） ng/L and PCT levels（0. 204±0. 097）μg/L,（0. 439± 0. 152） /,g/L, （1. 132±0. 471） μg/L among three observation subgroups showed significant difference（ P 〈0.05） ,and the indexes became higher with severe degree of heart failure. PCT （0. 068 ± 0. 295） μg/L, （0. 097 ± 0. 035） μg/L, （0.170±0.059） μg/Land NT - proBNPlevels（494±82） ng/L,（842±299） ng/L,（1 392±422）ng/Lin patients of three subgroups were significantly lower after treatment compared with before treatment （ P 〈0.05）. Conclusion NT-proBNP and PCT were two objective indicators of the severity and treatment effect in patients of AECOPD with heart failure.