N-端钠尿肽前体在慢性阻塞性肺疾病合并肺心病患者中的应用价值

Application Value of NT-proBNP in Patients with Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Heart Disease

目的探讨N-端钠尿肽前体(NT-proBNP)检测在对慢性阻塞性肺疾病(COPD)合并肺心病患者中对右心功能的评估价值。方法选择中国人民解放军第八十八医院呼吸内科2016年6月—2017年3月收治的156例COPD合并肺心病患,随机分为对照组(n=78)及观察组(n=78),检测血浆NT-proBNP,并采用超声心动图检测两组患者的肺动脉压力、右房室瓣舒张早期E波峰值(TVE)/右房室瓣舒张晚期A波峰值(TVA)右心功能(E/A),并进行对比分析。结果观察组肺动脉压力(t=29.592,P=0.000)及NT-proBNP均显著高于对照组(t=24.877,P=0.000),E/A值显著低于对照组(t=5.419,P=0.000);观察组中,中、重度肺动脉高压患者NT-proBNP显著高于轻度肺动脉高压患者(t=19.264,P=0.000;t=31.64,P=0.000),重度肺动脉高压患者NT-proBNP显著高于中度患者(P=17.012,P=0.000);观察组NT-proBNP与肺动脉压力呈显著正相关(r=0.461,P=0.002),NT-proBNP与E/A值呈显著负相关(r=-0.231,P=0.008)。结论 NT-proBNP的检测能够较为准确、可靠的反应COPD合并肺心病患者的右心功能,简便易行,值得推广。

Objective To discuss the clinical evaluation of NT-proBNP on right ventricular function in patients with COPD complicated with PHD. Methods 156 cases of patients who were treated in our department of 88 th hospital of PLA with COPD from June 2016 to March 2017 were selected and randomly divided into control group（n=78） and observation group（n=78）, the blood plasma NT-proBNP was tested, and the pulmonary artery pressure, TVE, TVA, E/A were compared and analyzed. Results The pulmonary artery pressure（t=29.592, P=0.000） and NT-proBNP in the observation group were obviously higher than those in the control group（t=24.877, P=0.000）, and the E/A value was obviously lower than that in the control group（t=5.419, P=0.000）, and the NT-proBNP in the patients with moderate and high pulmonary artery pressure was obviously higher than that of patients with mild pulmonary artery pressure（t=19.264,P=0.000; t =31.64, P =0.000）, and the NT-proBNP in the patients with severe pulmonary artery pressure was obviously higher than that of moderate patients（P=17.012, P=0.000）, and the NT-proBNP had an obvious positive correlation with the pulmonary artery pressure（r=0.461, P=0.002）, and the NT-proBNP had an obvious negative correlation with the E/A value（r=-0.231, P=0.008）. Conclusion The test of NT-proBNP can accurately and reliably reflect the right cardiac function of patients with COPD combined with pulmonary heart disease, and it is simple and feasible, and it is worth promotion.