超敏c反应蛋白及B型脑钠肽检测在慢性阻塞性肺疾病合并肺心病诊疗中的应用价值

Clinical value of hs 一 CRP and BNP detection in the diagnosis and treatment of COPD patients with pulmonary heart disease

目的探讨超敏C反应蛋白(hs-CRP)、B型脑钠肽(BNP)检测在慢性阻塞性肺疾病(COPD)合并肺心病患者中的应用价值。方法选取2016年1月至2018年1月大同市第五人民医院收治的COPD患者80例为研究对象,其中42例合并肺心病者为COPD合并肺心病组,38例未合并COPD者为单纯COPD组,30例健康志愿者为对照组。比较各组受检者hs-CRP.BNP水平的差异,分析hs-CRP.BNP对COPD合并肺心病的诊断价值。比较不同心功能分级COPD合并肺心病患者hs-CRP、BNP的差异。结果COPD合并肺心病组、单纯 COPD 组及对照组 hs-CRP [(72.5 ± 20.4) mg/L 比(37.5 ± 9.8 ) mg/L 比(3.7 ± 1.2) mg/L]、BNP[(362.8 ±86.9) ng/L 比(125.9 ±34.8) ng/L 比(28.5 ±9.9)ng/L],差异均有统计学意义(F = 9.245,14.668,均P<0.05)。组间两两比较,COPD合并肺心病组显著高于其他两组(t = 19.294,11.576、21.385、9.258、9.258,均P<0.05),单纯COPD组显著高于对照组,差异均有统计学意义(t =8.912 J2.567.均P<0.05 ) 0BNP诊断COPD患者合并肺心病的最佳界值为261.8 ng/L,其诊断敏感度、特异度分别为96.2%和85.4%,线下面积为0.834,均高于hs-CRP随着心功能分级的增加,COPD合并肺心病患者hs-CRP [(38.5 ±10.3)mg/L比(51.4 ± 14.8)mg/L 比(75.1 ±21.5)mg/L 比(93.7 ±31.8)mg/L]、BNP[( 142.8 ±56.5)ng/L 比(285.9 ±94.8) ng/L比(352.5 ±118.2) ng/L比(478.5 ± 130.3) ng/L]水平呈升高趋势,差异均有统计学意义(F=13.577 J6.776,均P <0.05)。hs-CRP.BNP与COPD合并肺心病患者心功能分级存在明显相关(r =0.675 .0.766,均P <0.05)。结论hs-CRP、BNP对COPD合并肺心病具有较高的诊断价值,且与患者心功能分级呈正相关。

Objective To investigate the application value of hs一CRP and BNP detection in COPD patients with pulmonary heart disease.Methods From January 2016 to January 2018,80 patients with COPD in the Fifth Peoples Hospital of Datong were selected.Forty-two COPD patients complicated with pulmonary heart disease were selected as COPD and cor pulmonale group,38 COPD patients without pulmonary heart disease were selected as COPD group,and 30 healthy volunteers were selected as control group.The differences of hs-CRP and BNP levels were compared,and the diagnostic value of hs-CRP and BNP for COPD combined with pulmonary heart disease was analyzed.Results There were statistically significant differences in hs-CRP[(72.5±20.4)mg/L vs.(37.5±9.8)mg/L vs.(3.7±1.2)mg/L],BNP[(362.8±86.9)ng/L vs.(125.9±34.8)ng/L vs.(28.5±9.9)ng/L]among the COPD and cor pulmonale group,COPD group and control group(t=9.245,14.668,all P<0.05).The hs-CRP and BNP levels in the COPD and cor pulmonale group were significantly higher than those in the other two groups(t=19.294,11.576,21.385,9.258,9.258,all P<0.05),which of the COPD group were significantly higher than those of the control group(t=8.912,12.567,all P<0.05).The best boundary value of BNP in diagnosis of COPD with cor pulmonale was 261.8ng/L,and its diagnostic sensitivity and specificity were 96.2%and 85.4%,respectively,the area under the line was 0.834,which were all higher than those of hs-CRP.With the increase of cardiac function,the levels of hs-CRP[(38.5±10.3)mg/L vs.(51.4±14.8)mg/L vs.(75.1±21.5)ing/L vs.(93.7±31.8)mg/L],BNP[(142.8±56.5)ng/L vs.(285.9±94.8)ng/L vs.(352.5±118.2)ng/L vs.(478.5±130.3)ng/L]increased,the differences were statistically significant(F=13.577,16.776,all P<0.05).There were significant correlation between hs-CRP,BNP levels and COPD patients complicated with cor pulmonale(r=0.675,0.766,all P<0.05).Conclusion hs-CRP and BNP have high diagnostic potency for COPD patients combined with cor pulmonale,and are positively conelated with cardiac function classification.