血浆脑钠肽水平对老年慢性阻塞性肺疾病患者肺动脉高压及预后的评估价值

Significance of plasma BNP level in the assessment of prognosis for the elderly pulmonary hypertension patients with chronic obstructive pulmonary disease

目的分析血浆脑钠肽（BNP）水平对老年慢性阻塞性肺疾病（COPD）患者肺动脉高压（PH）及预后的评估价值。方法选取100例老年COPD患者作为病例组，根据其疾病类型将其分为AECOPD组（ A组，29例）、AECOPD合并PH组（ B组，44例），COPD稳定期组（ C组，共27例），根据B组患者的肺动脉收缩压（PASP）水平将其为轻度组（35 mm Hg＜PASP≤45 mm Hg，14例）、中度组（45 mm Hg＜PASP磠55 mm Hg，15例）和重度（ PASP＞55 mm Hg，15例）三个亚组。选取40例健康老年人作为对照组。对所有纳入研究对象的血浆BNP水平、动脉血氧分压（ PaO2）水平进行分析；对B组患者的生存时间进行随访。结果 C组、A组、B组患者的血浆BNP水平依次升高且均显著高于对照组（q＝4．725～6．127，P＜0．05）；B组患者的PaO2水平显著低于A组且均显著低于C组或对照组（q＝3．155～3．751，P＜0．05）；随着PH病情的加重，患者的血浆BNP水平上升（q＝5．623～8．435，P＜0．05），重度组患者的PaO2水平显著低于轻度组或中度组（q＝3．254、3．538，P＜0．05），患者的血浆BNP水平与PaO2水平呈负相关（r＝－0．362，P＜0．05）而与PASP呈正相关（ r＝0．772，P＜0．05）。结论老年AECOPD合并PH患者血浆BNP水平显著升高，其升高幅度与病情严重程度具有相关性，但不能用于预测患者的预后情况。

Objective To analyze the significance of plasma brain natriuretic peptide （ BNP） level in the as-sessment of prognosis for the elderly pulmonary hypertension（ PH） patients with chronic obstructive pulmonary disease （COPD）.Methods 100casesofelderlypatientswithCOPDwereselectedanddividedintotheAECOPDgroup （ group A,29 cases） ,the AECOPD complicated with PH group （ group B,44 cases） ,the stable phase of COPD group （ group C,27 cases） according to the type of the diseases.According to the levels of pulmonary artery systolic pressure （ PASP） ,the patients in group B were divided into three subgroups：the mild group （35 mm Hg＆lt;PASP≤45 mm Hg, 14 cases）,the moderate group （45 mm Hg＆lt;PASP≤55 mm Hg,15 cases） and the severe group （PASP＆gt;55 mm Hg,15 cases） .40 cases of healthy elderly people were selected as the control group.The level of plasma BNP,the ar-terial oxygen partial pressure （ PaO2 ） of all included subjects were tested and compared.The survival time of the pa-tients in group B was followed up and compared.Results The plasma BNP levels of the patients in group C,group A and group B were increased gradually and were all higher than that in the control group （ q=5.367-18.306,P＆lt;0.05）;The arterial blood PaO2 level of the patients in group B was lower than that in group A,and both were signifi-cantly lower than that in group C or the control group （q=3.155-3.751, P ＆lt;0.05）;the plasma BNP level of the patients increased gradually with the deterioration of the PH,（q =6.358-10.391,P ＆lt;0.05）.The arterial blood PaO2 level of the patients in the severe group was significantly lower than that in the mild group and the moderate group （q =3.254,3.538,P＆lt;0.05）.The plasma BNP level of patients was negatively correlated with the arterial blood PaO2 level （r=-0.406,P＆lt;0.05） and positively correlated with PASP （ r=0.862,P＆lt;0.05） of the pa-tients.Conclusions The increased plasma BNP amplitude,with is associated with the severity of the diseases,could be used as an auxiliary index in the evaluation of the patients’ disease progress.However,there is an absence of cor-relation between the level and the prognosis of the patients,and the index cannot be used to predict the prognosis of the patients.