慢性肺源性心脏病失代偿期患者N-端脑利钠肽前体水平变化及其临床意义

Level of N-terminal pro-brain natriuretic peptide and its clinical significance in patients with decompensated chronic cor pulmonale

目的:探讨慢性肺源性心脏病失代偿期患者血浆N-端脑利钠肽前体(NT-proBNP)的变化及其临床意义。方法:将2012年1月至2015年1月广东省江门市新会区第二人民医院收治的69例慢性肺源性心脏病失代偿期患者与52例慢性阻塞性肺疾病(COPD)患者作为研究对象,采用快速电化学发光法分别测定两组患者血浆NT-proBNP浓度,并行血气分析和心脏彩色超声检查。待治疗缓解后复查血浆NTproBNP浓度。结果:慢性肺源性心脏病失代偿期患者急性加重期NT-proBNP浓度显著高于COPD急性加重期患者(P<0.05),各组急性加重期NT-proBNP浓度显著高于缓解期(P<0.05)。慢性肺源性心脏病失代偿期患者急性加重期血浆NT-proBNP水平与肺动脉压、右心室舒张期内径、右心室流出道宽度、总血红蛋白呈正相关(P<0.05);COPD患者急性加重期NT-proBNP水平与PAP呈正相关(P<0.05)。结论:血浆NT-proBNP参与了肺源性心脏病的病理生理过程,测定NT-proBNP浓度有助于判断肺源性心脏病病情严重程度。

Objective：To investigate the level of N-terminal pro-brain natriuretic peptide （ NT-proBNP ） and its clinical significance in patients with decompensated chronic cor pulmonale. Methods：Included in this study were 69 patients with decompensated chronic cor pulmonale （ CCP ） and 52 patients with chronic obstructive pulmonary disease （COPD） treated for acute exacerbation of their condition at Xinhui District Second People＆#39;s Hospital of Jiangmen between January 2012 and January 2015. Rapid electrochemiluminescence assay was used to measure the plasma level of NT-proBNP in the patients. The patients also underwent blood gas analysis and color Doppler cardiac ultrasonography. When remission was achieved,the patients received a follow-up measurement of plasma NT-proBNP. Results： During acute exacerbation, patients with decompensated CCP had significantly higher level of NT-proBNP than those with COPD （P〈0.05）. In either group of patients,the NT-proBNP level was significantly higher during acute exacerbation than during remission （ P〈0.05） . During an acute exacerbation of decompensated CCP,the plasma NT-proBNP level was positively correlated with the pulmonary artery pressure, diameter of right ventricle during diastolic phase, width of right ventricular outflow tract, and total hemoglobin （ P〈0.05） . Conclusion： The plasma NT-proBNP may be involved in pathophysiology of cor pulmonale. Measurement of NT-proBNP level may help determine the severity of cor pulmonale.