慢性阻塞性肺疾病和肺心病患者利钠肽水平临床研究

A clinical research on NT-proBNP and ANP in COPD and chronic pulmonary heart disease

目的观察慢性肺源性心脏病(肺心病)和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期(治疗前)、缓解期(治疗后)的血清氨基末端B型脑钠肽前体(NT-proBNP)、心房利钠肽(atrial natriuretic peptide,ANP)的水平差异能否作为判断病情严重程度的指标以及血浆肌钙蛋白T(troponin T,cTNT)、肌钙蛋白I(troponin I,c TNI)增高对患者预后的判断有无意义。方法选取2014年6月至2015年12月于本院住院的COPD患者55例作为COPD组,选取同期住院的COPD并发肺心病患者57例作为肺心病组。两组患者入院后根据病情接受抗感染、解痉、化痰等治疗,肺心病组患者在上述治疗的基础上给予利尿剂及扩血管剂治疗,两组患者治疗前与治疗10天后分别检查NT-proBNP、ANP、cTNT、c TNI、动脉血气分析。结果肺心病组患者治疗前的NT-proBNP、ANP水平显著高于COPD组,差异具有显著性(P<0.01)。肺心病组患者经过治疗后的NT-proBNP、ANP水平均有明显下降,治疗前后相比较差异具有显著性(P<0.01),而COPD组患者的NT-proBNP、ANP水平治疗前后差异无显著性(P>0.05)。肺心病组患者中有5例(8.8%)出现cTNT、c TNI增高,其平均住院时间(25天)明显高于同组其他患者(14天),其中2例患者出院后30天内再次住院。结论 NT-proBNP、ANP可以作为判断慢性肺源性心脏病急性加重期病情严重程度的指标之一,cTNT、c TNI对慢性肺源性心脏病患者预后的判断有一定的意义。慢性肺源性心脏病缓解期的NT-proBNP水平可以评价病情严重程度,优于ANP。ANP和NT-proBNP难以作为判断COPD急性加重期的病情严重程度指标之一。

Objective The first objective of this paper is to find out whether NT-proBNP and ANP could be the indicator of the severity of chronic obstructive of pulmonary disease and chronic pulmonary heart disease, by comparing them in acute exacerbation （before treatment） with those in stable stage （after the treatment）.The second objective is to find out if cTNT and cTNI are prognostics indicator of those two chronic diseases.Method The patients of those two diseases are given oxygen, anti-infectious, relieving bronchial spasm and resolving phlegm therapy. In addition, the patients of chronic corpulmonale are also given diuretics and vasodilator. NT-proBNP, ANP, cTNT,cTNI and blood gas analysis were detected before treatment and in the 10th day after the treatment.Result In chronic corpulmonale,NT-proBNP and ANP at acute exacerbation stage were significantly higher than those in COPD（P〈0.01）, after the treatment they declined sharply（P〈 0.01）. The difference of NT-proBNP and ANP of chronic corpulmonale patients between before the treatment and after the treatment had statistical significance, while it had no statistical significance in COPD. On the other hand, in the patients of chronic corpulmonale there were 5 （8.8%） patients’ cTNT and cTNI higher above normal, and their average hospitalized days （25 days） are much more than other patients （14 days）. Two of those five patients were readmitted in 30 days after discharge.Conclusion NT-proBNP and ANP can be the indicator of acute exacerbation severity of chronic pulmonary heart disease, and cTNT,cTNI are helpful to predict prognosis. For patients of stable chronic pulmonary heart disease, NT-proBNP can be a better indicator of severity than ANP. However,ANP and NT-proBNP can’t be the indicator of severity of AECOPD.