血清BNP、HCY及Hs-CRP在肺心病患者病情评估中的临床意义

Clinical significance of serum brain natriuretic peptide, homocysteine and hypersensitive C-reactive protein in evaluating severity in patients with chronic pulmonary heart disease

目的探讨血清脑钠肽(BNP)、同型半胱氨酸(HCY)、超敏C反应蛋白(Hs-CRP在慢性肺源性心脏病患者病情评估中的临床意义。方法收集2015年1月至2018年1月于湖州市第一人民医院因慢性肺源性心脏病住院的患者180例(包括肺心功能失代偿组100例,肺心功能代偿组80例),选择同期于医院进行体检的健康人群80例为对照组,收集患者基本资料、血检测BNP、HCY、Hs-CRP、胆固醇、肌酐及心脏超声肺动脉压力指标,利用单因素方差分析,比较各组BNP、HCY、Hs-CRP等差异,根据肺心功能失代偿患者存活情况进一步分为死亡组(25例)和存活组(75例),比较两组间BNP、HCY、Hs-CRP差异;并对慢性肺源性心脏病患者入院时、出院前BNP、HCY、Hs-CRP进行比较。结果肺心功能失代偿组血BNP、HCY、Hs-CRP值明显高于肺心功能代偿组和对照组(F=403.021;93.082;186.215;均P<0.05),肺心功能代偿组上述指标高于对照组;死亡组入院时血BNP、HCY、Hs-CRP值显著高于存活组(t=11.263;10.582;6.234;均P<0.05);根据慢性肺源性心脏病患者治疗效果分为病情好转组(155例)和病情未好转组(25例),病情好转组中出院前血BNP、HCY、Hs-CRP值明显低于入院时(t=10.806;3.911;3.782;均P<0.05),病情未好转组中出院前血BNP、HCY、Hs-CRP值明显高于入院时,差异具有统计学意义(t=-11.062;-4.843;-9.451;P<0.05)。结论血清BNP、HCY、Hs-CRP升高与慢性肺源性心脏病的病情严重程度相关,且对慢性肺心病患者治疗疗效监测及短期预后评估有一定意义。

Objective To explore the clinical significance of serum brain natriuretic peptide(BNP), homocysteine(Hcy) and hypersensitive C-reactive protein(Hs-CRP) in the evaluation of patients with chronic pulmonary heart disease. Methods 180 hospitalized patients with chronic pulmonary heart diseasein Huzhou first people’s hospital from January 2015 to January 2018 were collected(including 100 cases of decompensated pulmonary and cardiac function, 80 cases of compensated pulmonary and cardiac function). 80 healthy people who had physical examination in the hospital at the same time were selected as the control group. Basic document of patients, blood examination such as BNP, Hcy, HsCRP, cholesterol, creatinine, cardiac uhrasonography,pulmonary artery pressure were collected. One-way ANOVA was used to compare the differences of BNP, Hcy and Hs-CRP in each group. According to the survival of patients with decompensated pulmonary and cardiac function, they were further divided into death group(25 cases) and survival group(75 cases), the differences of BNP, Hcy and Hs-CRP between the two groups were compared, as well as the levels of BNP, Hcy and Hs-CRP at admission and before discharge. Results The levels of BNP, Hcy and Hs-CRP in the decompensated pulmonary and cardiac function group were significantly higher than those in the compensated pulmonary and cardiac function group and the control group(F=403.021;93.082;186.215;P<0.05), and those in the compensated pulmonary and cardiac function group were higher than those in the control group. The levels of BNP, Hcy and Hs-CRP in the death group were significantly higher than those in the survival group(t=11.263;10.582;6.234;P<0.05). According to the therapeutic effect of patients with chronic pulmonary heart disease, they were divided into two groups:the improved group(155 cases) and the unimproved group(25 cases).The levels of BNP, Hcy and Hs-CRP in improved group before discharge were significantly lower than those at admission(t=10.806;3.911;3.782;P<0.05), while those in unimproved group before discharge were obviously higher than those at admission(t=-11.062;-4.843;-9.451;P<0.05). Conclusion The elevation of serum BNP, Hcy and Hs-CPR is related to the severity of chronic pulmonary heart disease, and has some significance in monitoring the therapeutic effect and evaluating short-term prognosis of patients with chronic pulmonary heart disease.