D-二聚体、B型钠尿肽与血气在慢性阻塞性肺疾病继发肺栓塞的预测价值

Predictive value of D-dimer,B-type natriuretic peptide and blood gas indexes in risk of secondary pulmonary thromboembolism in patients with chronic obstructive pulmonary disease

目的探讨血浆D-二聚体、B型钠尿肽和血气(PaO 2、PaCO 2)在高风险慢性阻塞性肺疾病急性加重期(AECOPD)继发肺栓塞(PTE)的预测价值。方法选取于2016年1月至2017年12月期间在我院住院的32例高风险AECOPD继发PTE的患者作为血栓组;同期住院60例高风险AECOPD未继发PTE的患者为高风险单纯COPD组;另选择同期住院的52例低风险AECOPD(未继发PTE)患者为低风险COPD组。对所有入选的患者行血浆D-二聚体、B型钠尿肽(BNP)及血气分析检查并进行对比分析。结果高风险AECOPD患者(血栓组和高风险单纯COPD组)的血浆D-二聚体、BNP的均值均高于低风险COPD组患者,血栓组患者血浆D-二聚体均值又高于高风险单纯COPD组患者,差异均具有统计学意义(P<0.05)。血栓组患者的PaCO 2及PaO 2均值均低于高风险单纯COPD组及低风险COPD组患者,差异均具有统计学意义(P<0.05)。高风险单纯COPD组患者PaCO 2高于低风险COPD组患者(P<0.05),但两组间PaO 2均值差异无统计学意义。结论高风险AECOPD患者的血浆D-二聚体、BNP水平升高,低氧血症、二氧化碳潴留,继发肺栓塞时,D-二聚体及BNP升高更明显,低氧进一步加重,且在原有高二氧化碳水平的基础上出现PaCO 2下降,均值>5 mmHg,提示血浆D-二聚体、BNP与血气分析检测在判断高风险AECOPD继发肺栓塞的风险中有较高的预测价值,能为临床及时判断高风险AECOPD患者早期抗凝治疗提供重要的依据。

Objective To investigate the predictive value of plasma D-dimmer,B-type natriuretic peptide(BNP)and blood gas indexes in secondary pulmonary thromboembolism(PTE)during the high-risk of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 32 patients with high-risk AECOPD+secondary PTE,treated in our hospital from January 2016 to December 2017,were collected as the thrombosis group,60 patients with high-risk of AECOPD without secondary PTE,treated at the same period,were selected as the simple high-risk COPD group,and 52 patients with low-risk COPD during the period of acute exacerbation(without secondary PTE),treated at the same period,were selected as the low-risk COPD group.The plasma D-dimmer,BNP,and blood gas indexes[the arterial partial pressure of oxygen(PaO 2)and the arterial partial pressure of carbon dioxide(PaCO 2)]were detected and analyzed in all the patients.Results The mean values of plasma D-dimmer and BNP in the thrombosis group and the simple high-risk COPD group were higher than those of the low-risk COPD group.The mean value of plasma D-dimmer in the thrombosis group was higher than that of the high-risk COPD group,and statistical significant differences were found between the two groups(P<0.05).The PaCO 2 and PaO 2 in the thrombosis group were lower than those of the simple high-risk COPD group and the low-risk COPD group,and statistical significant differences were found between the two groups(P<0.05).The patients with simple high-risk COPD had higher PaCO 2 than the patients with low-risk COPD(P<0.05),however,there was no statistical significant difference in the mean PaO 2 between the two groups.Conclusion In the patients with high-risk AECOPD,the plasma D-dimmer and BNP levels are elevated,and hypoxemia and carbon dioxide retention occur.When combined with pulmonary thromboembolism,the D-dimmer and BNP levels increase more significantly,the symptoms of hypoxia are further aggravated.And on the basis of original high carbon dioxide,there is a decrease in the PaCO 2,with a mean value greater than 5 mm Hg,suggesting that the plasma D-dimmer,BNP,and blood gas analysis tests have a good predictive value in judging the high-risk AECOPD associated with pulmonary embolism.It can provide an important basis for early clinical anticoagulant therapy for the patients with acute exacerbation of high-risk COPD.