血清NT⁃proBNP、D⁃二聚体、ST2水平与COPD合并呼吸衰竭患者预后的相关性分析

Correlation between serum NT⁃proBNP,D⁃dimer and ST2 levels and prognosis in patients with COPD and respiratory failure

目的分析血清氨基末端B型钠尿肽原(NT⁃proBNP)、D⁃二聚体(D⁃D)、人基质裂解素(human matrix lysin,ST2)水平与慢性阻塞性肺疾病(COPD)合并呼吸衰竭(简称呼衰)患者预后的相关性。方法选取2018年3月至2019年7月本院112例COPD合并Ⅱ型呼衰患者为研究对象,根据其30 d内预后情况分为死亡组(预后不良组)及生存组(预后良好组),并纳入同期健康体检者56例作为健康对照组。比较3组性别、年龄、入院时动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、COPD评估测试(CAT)等基线资料及血清NT⁃proBNP、D⁃D、ST2水平差异,并使用受试者工作特征曲线(ROC曲线)评估入院时血清NT⁃proBNP、D⁃D、ST2水平对COPD合并Ⅱ型呼衰患者不良预后的预测价值。结果112例COPD合并Ⅱ型呼衰患者入院后30 d死亡31例(27.68%),纳入预后不良组;生存81例(72.32%),纳入预后良好组。3组性别比较,差异无统计学意义(P>0.05);预后不良组与预后良好组年龄、PaO2比较,差异无统计学意义(P>0.05),但年龄均高于健康对照组(P<0.05),PaO2均低于健康对照组(P<0.05);3组PaCO2及血清NT⁃proBNP、D⁃D、ST2水平比较,为预后不良组>预后良好组>健康对照组(P<0.05);且预后不良组CAT评分高于预后良好组(P<0.05)。经ROC曲线分析,发现血清NT⁃proBNP、D⁃D、ST2水平均对COPD合并Ⅱ型呼衰患者不良预后具有较高预测价值(AUC=0.955、0.931、0.946,P<0.05),其cut⁃off值分别为709.66 pg/L、532.47 ng/L、463.48 ng/L。结论血清NT⁃proBNP、D⁃D、ST2对COPD合并Ⅱ型呼衰预后预测价值较高,有助于临床诊疗。

Objective To analyze the correlation between serum N⁃terminal pro⁃brain natriuretic peptide(NT⁃proBNP),D⁃dimer(D⁃D)and human matrix lysin(ST2)levels and prognosis of patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods From March 2018 to July 2019,112 patients with COPD and typeⅡrespiratory failure in our hospital were selected as the research subjects.According to their prognosis within 30 days,they were divided into death group(poor prognosis group)and survival group(good prognosis group).Fifty⁃six healthy subjects were included as healthy controls.Compare the baseline data of gender,age,partial arterial oxygen pressure(PaO2),partial arterial carbon dioxide pressure(PaCO2),and COPD assessment test(CAT)and serum NT⁃proBNP,DD,and ST2 levels in the three groups.The receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of serum NT⁃proBNP,DD,and ST2 levels at the time of admission to the adverse prognosis of COPD patients with typeⅡrespiratory failure.Results Thirty⁃one patients(27.68%)who died of COPD combined with typeⅡrespiratory failure 30 days after admission were included in the poor prognosis group;81 patients(72.32%)survived and were included in the good prognosis group.There was no significant difference in gender comparison between the three groups(P>0.05).There was no significant difference in age and PaO2 between the poor prognosis group and the good prognosis group(P>0.05),but the age was higher than the healthy control group(P<0.05).PaO2 was lower than the healthy control group(P<0.05).PaCO2 and serum NT⁃proBNP,DD,ST2 levels of the three groups were poor prognosis group>good prognosis group>healthy control group(P<0.05).The CAT score of the poor prognosis group was higher than that of the good prognosis group(P<0.05).ROC curve analysis found that serum NT⁃proBNP,DD,and ST2 levels had a high predictive value for the poor prognosis of patients with COPD combined with typeⅡrespiratory failure(AUC=0.955,0.931,0.946,P<0.05),and their cut⁃off values are 709.66 pg/mL,532.47 ng/mL,and 463.48 ng/L.Conclusion Serum NT⁃proBNP,D⁃D and ST2 have higher predictive value on prognosis of COPD with typeⅡrespiratory failure,which is helpful for clinical diagnosis and treatment.