慢性阻塞性肺病急性加重期血浆N端B型钠尿肽原的临床意义

目的：探讨血浆N端B型钠尿肽原（NT—proBNP）评价慢性阻塞性肺病急性加重期（AECOPD）右G功能的应用价值。方法：130例AECOPD患者，以0脏超声检查中平均肺动脉压（MPAP）为标准，将其分为MPAP正常组a、MPAP轻度升高组b、MPAP中重度升高组C；根据临床表现分为肺l心功能代偿期A、肺心功能失代偿期之呼吸衰竭期B、肺心功能失代偿之右心衰竭期c三组。结果：b、C二组MPAP、NT—proBNP、右室舒张末期内径（RVD）、右室前壁厚度（RVAwT）、收缩末期右心室内径（RVDs）／收缩末期左．心室内径（LVDs）明显升高，B、C组NT—proBNP、尿酸、超敏c反应蛋白明显升高，组间比较差异均有统计学意义（P〈0．05）。上述各参数与NT—proBNP呈线性正相关。B、C组桡动脉血氧分压（PaO2）降低（P〈0．05），与NT—proBNP呈线性负相关。结论：血浆NT—proBNP水平检测有助于鉴别AECOPD呼吸困难是否合并右0功能不全，并且可以评估其严重程度；其水平受肺动脉高压及右l心衰竭严重度、炎性应激、低氧血症三方面因素影响。

Objective： in patients with AECOPD more exactly for the further study of their application value of NT -proBNP assessing the function of fight heart. Method ： According to the mean pulmonary artery pressure （ MPAP ） level after given ultrasonic Doppler echocardiography examination, divide the 130 patients with qualified AECOPD who were chosen out at random into three groups： group a： with normal MPAP level; group b： wlth mild increased MPAP level and group c MPAP le;,el, According to clinical manifestation, divide the 130 patients into another three groups ： group A ： in the stage of pneumocardial compensation, group B ： in the stage of respiratory failure of pulmonary cardiac decompensation and group C ： in the stage of right heart. Use the One - way T test, variance and regression to analyze the correlation between plasma NT - proBNP levels and the other indexes, At last, evaluate those iaffuential factors on NT - proBNP in diagnosing AECOPD with right heart failure. Results： The analysis statistics of groups b and c of NT - proBNP, the RVD, RVAWT and RVDs / LVDs are significant higher in group b and c which patients are with increased MPAP level than group a which patients are with normal MPAP level, which has a statistical significance （P 〈 0. 05 ）. The analysis statistics of groups A,B and C tells that the plasma levels of NT -proBNP, the plasma levels of UA and hs - CRP are improved in group B and C,which has a statistical significance （P 〈0. 05）. And there were linear regression relationship between plasma levels of NT -proBNP and UA, hs - CRP. The levels of PaO2in group b and c are both lower than that in group a, which has a statistical significance （ P 〈 0. 05 ） and the plasma NT - proBNP level is negatively correlated with PaO2at acute exacerbation stage. Conclusion ： The present study demonstrates that measuring the plasma NT - pmBNP level is helpful to differentiate dyspnea whether to merge the right heart failure and to evaluate the severity of the right heart failure. Furthermore, it also shows that the plasma NT - proBNP level is affected by the severity of PAH or right heart failure, inflammatory stress and hypoxemia.