N末端脑钠肽前体对慢性阻塞性肺疾病急性加重期合并左心衰的诊断价值

Diagnostic value of N-terminal-pro-brain natriuretic peptide for patients with acute exacerbation of chronic obstructive pulmonary disease complicated with left heart failure

目的：探讨N末端脑钠肽前体（NT—proBNP）对慢性阻塞性肺疾病急性加重期（AECOPD）合并左心衰的诊断价值。方法：收集2014年3月至2015年2月期间，呼吸内科病房确诊或既往诊断为AECOPD的患者109例，根据心脏彩超及临床特点将患者分为左心衰组（A组，21例）及非左心衰组（B组，88例），探讨影响AECOPD患者血浆NT—proBNP升高的相关因素，以及NT-proBNP对AECOPD合并左心衰的诊断价值，并拟出排除及诊断截点。结果：重线性回归分析提示NT—proBNP与降钙素原PCT（卢=0．180，P=0．011）、肺动脉压PAP（β=0．333，P：0．000）呈正相关，与左室射血分数LVEF（β=-0．511，P=0．000）呈负相关，NT—proBNP的ROC曲线下面积（AUC）为0．959（95％CI：0．915～1．002，P=0．000）．排除截点为794．6pg／mL（敏感性：90．5％，特异性：92％），诊断截点为1618pg／mL（敏感性：85．7％，特异性：97．7％）。结论：NT—proBNP可协助诊断AECOPD患者是否合并左心衰。除左心功能不全外，系统炎症、肺动脉高压状态也可能是影响AECOPD患者NT—proBNP升高的因素。

Objective To discuss the diagnostic value of N-terminal-pro-brain natriuretic peptide （NT- proBNP） for patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with left heart failure. Methods Patients with medical history of AECOPD, or are diagnosed as AECOPD from March 2014 to February 2015 were involved in the study. Based on echocardiography and clinic characteristics, the patients were divided into left heart failure group （group A） and non-left heart failure group （group B）. Related factors of elevated NT-proBNP in AECOPD and the diagnostic value of NT-proBNP for patients with AECOPD complicated with left heart failure were analyzed, and exclusive and diagnostic cutoff were worked out. Results In this study, 109 AECOPD patients were collected, including 21 patients in group A and 88 patients in group B. Multivariate linear regression analysis indicated NT-proBNP was positively associated with PCT （[3= 0.180,P = 0.011） and PAP（β = 0.333,P = 0.000）, and negatively with LVEF（β = -0.511 ,P = 0.000）and the area under the ROC curve（AUC） was 0.959 （95% confidence interval：0.915-1.002,P = 0.000）. The exclusive cutoff was 794.6 pg/mL（sensitivity ： 90.5%, specificity ： 92% ）, and the diagnostic cutoff 1 618 pg/mL （ sensitivity ： 85.7% ,specificity： 97.7%）. Conclusions NT-proBNP can help to diagnose whether AECPOD patients are complicated with left heart failure. Besides left heart dysfunction and the state of systemic inflammation, pulmonary hypertension may be the reasons for the elevated NT-proBNP in AECOPD patients.