心功能与慢性阻塞性肺疾病伴肺心病患者NT-pro BNP和血脂水平的相关性研究

Relationship study between heart function and NT-pro BNP and blood lipid levels in patients with COPD complicated with CP

目的探讨慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,慢阻肺),伴慢性肺源性心脏病(Cor Pulmonale,CP)患者心功能与N-末端脑钠肽前体(N-terminal pro-B-style natriuretic peptide,NT-pro BNP)和血脂水平的相关性研究。方法荧光免疫分析和生化法测定了188例慢阻肺伴肺心病患者(心功能Ⅰ级-Ⅳ级)、123例慢阻肺患者和72例正常对照组血浆NT-pro BNP和血脂[TC、TG、HDL-C、LDL-C和LP(a)]水平,并进行对比性研究。结果 188例慢阻肺伴肺心病患者血浆NT-pro BNP水平随心功能Ⅰ级-Ⅳ级的严重程度而增高,较之72例正常对照组和123例慢阻肺患者均明确增高(P分别为<0.05、<0.01、<0.001和<0.001)。123例慢阻肺患者较之正常对照组无明显差异(P>0.05)。188例慢阻肺伴肺心病患者血清TC、TG、HDL-C和LP(a)水平随心功能Ⅰ级-Ⅳ级的严重程度而降低,较之72例正常对照组和123例慢阻肺患者均明显降低(P>0.05-<0.001)。123例慢阻肺患者血清TC、TG和LDL-C水平较之正常对照组无明显差异(P均>0.05),HDL-C和LP(a)水平稍降低(P均<0.05)。结论血浆NT-pro BNP水平测定有助于鉴别肺源性和心源性呼吸困难,慢阻肺伴肺心病患者血浆NT-pro BNP随肺心病的严重程度而增高,血清TC、TG、HDL-C和LP(a)随肺心病严重程度而降低,有利于慢阻肺伴肺心病患者的早期诊断和及时治疗。

Objective To explore the relationship between heart function and NT-pro BNP and blood lipid levels in patients with COPD complicated with CP. Methods The plasma NT-pro BNP and blood lipid（[TC、TG、HDL-C、LDL-CandLP（a）] ）levels were determined in 188 COPD patients complicated with CP （heart function I-IV stage）, 123 patients with COPD and 72 normal controls by immunofluorescence assay and biochemistry. Results The plasma NT-pro BNP level in 188 COPD patients complicated with CP increased with severity and significantly higher than those in 72 normal controls and in 123 COPD patients （P 〈0. 05, P 〈0.01, P 〈0. 001 and P 〈0. 001 respectively）, but there was no significant difference between the COPD group and the control group （P 〉0. 05）. The serum levels of TC, TG, HDL-C and LP（a） in COPD patients complicated with CP decreased with severity and significantly lower than those in the control group and the COPD group （P 〉0. 05 - P 〈0. 001 ）. There was no sig- nitieant difference in serum TC, TG and LDL-C levels between the COPD group and the control group （ all P 〉 0. 05）. Conclusion NT-pro BNP level can help to differentiate pulmonary dyspnea and cardiac dyspnea. Serum NT-pro BNP level increases with severity, and serum TC, TG, HDL-C and LP（a） decrease in COPD patients com- plicated with CP, which is helpful for early diagnosis and therapy.