脑钠肽与肺动脉高压的关系及在肺动脉高压诊断中的临床价值

Relationship between Serum Brain Natriuretic Peptide and Pulmonary Hypertension and Its Diagnostic Value for Pulmonary Hypertension

目的 分析脑钠肽(BNP)与急性肺栓塞患者肺动脉高压的关系,探讨BNP诊断肺动脉高压的临床价值。方法 回顾性分析2013年3月至2016年8月承德医学院附属医院收治的74例经CT肺动脉造影确诊的急性肺栓塞患者的临床资料。根据心脏超声有无肺动脉高压表现分为有肺动脉高压组和无肺动脉高压组。以临床和理化检查变量为自变量,有无肺动脉高压为因变量进行多因素Logistic回归分析。通过受试者工作特征曲线(ROC曲线)分析BNP对肺动脉高压的诊断价值及确定最佳临界值。结果 74例急性肺栓塞患者中有肺动脉高压者38例,无肺动脉高压者36例。有肺动脉高压组BNP>100ng/L比例高于无肺动脉高压组[78.9%(30/38)比16.7%(6/36)](P<0.05),动脉血氧分压、动脉血二氧化碳分压低于无肺动脉高压组[(61±11)mmHg(1mmHg=0.133kPa)比(70±11)mmHg,(32±5)mmHg比(36±5)mmHg](P<0.05)。多因素Logistic回归分析结果显示,BNP>100ng/L是肺动脉高压的危险因素(P<0.05)。BNP诊断肺动脉高压的ROC曲线下面积为0.905(95%CI0.837~0.973),最佳临界值为112ng/L,灵敏度为76.3%,特异度为91.7%。结论 BNP>100ng/L是急性肺栓塞患者并发肺动脉高压的预测因素,BNP可以作为诊断肺动脉高压的可靠指标。

Objective To study the relationship between brain natriuretic peptide( BNP) and pulmonary hypertension in patients with acute pulmonary embolism,and to study the diagnostic value of BNP for pulmonary hypertension. Methods A retrospective study on 74 patients with pulmonary CT angiography diagnosed acute pulmonary embolism who were hospitalized in the Affiliated Hospital of Chengde Medical College during Mar. 2013 and Aug. 2016 was done.The patients were divided into a pulmonary hypertension group and a non-pulmonary hypertension group according to the echocardiography results.Clinical and physical-chemical testing variables were used as the independent variables and pulmonary hypertension as the dependent variable to conduct the multi-factor Logistic regression analysis.The diagnostic value and optimal cut-off value for BNP to predict pulmonary hypertension were analyzed by receiver operating characteristic(ROC) curve. Results There were 38 cases of pulmonary hypertension and 36 cases of no pulmonary hypertension in the 74 patients .The proportion of BNP>100 ng/L were higher than those in the non-pulmonary hypertension group[78.9%(30/38) vs 16.7%(6/36)]( P < 0.05 ),and the partial pressure of the arterial blood pressure and the arterial blood carbon dioxide were lower than those in the non-pulmonary hypertension group[(61±11) mmHg vs (70±11) mmHg,(32±5) mmHg vs (36±5) mmHg]( P <0.05). The multi-factor Logistic regression analysis showed that BNP>100 ng/L was the influencing factor of pulmonary hypertension( P <0.05).The area of the ROC curve for BNP was 0.905(95% CI 0.837-0.973),the optimal threshold was 112 ng/L,the sensitivity was 76.3%,and the specificity was 91.7%. Conclusion BNP> 100 ng/L is a predictive factor for pulmonary hypertension in patients with acute pulmonary embolism.BNP can be used as a reliable indicator for diagnosing pulmonary hypertension.