BNP、HCAR及D-D在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭中的变化及与病情、预后的相关性

Changes of BNP, HCAR and D-D Levels in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Combined with Type Ⅱ Respiratory Failure and Their Correlations with Pathogenetic Conditions and Prognosis

目的探讨脑钠肽(BNP)、超敏C反应蛋白/白蛋白比值(HCAR)及D-二聚体(D-D)在慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭中的变化及与病情、预后的相关性。方法选取2017年5月—2019年9月收治的138例AECOPD的患者,根据有无并发Ⅱ型呼吸衰竭分为合并Ⅱ型呼吸衰竭组66例和非Ⅱ型呼吸衰竭组72例。对比两组BNP、HCAR及D-D水平,分析三者与AECOPD合并Ⅱ型呼吸衰竭患者肺功能相关指标的相关性。分析影响AECOPD合并Ⅱ型呼吸衰竭患者死亡的危险因素。结果合并Ⅱ型呼吸衰竭组BNP、HCAR、D-D、二氧化碳分压(PCO_( 2))、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分均高于非Ⅱ型呼吸衰竭组,第1秒用力呼气容积占预计值百分比(FEV1%)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)、氧分压(PO_( 2))均低于非Ⅱ型呼吸衰竭组(P<0.01)。AECOPD合并Ⅱ型呼吸衰竭患者BNP、HCAR、D-D水平与FEV1%、FEV1/FVC、PO_( 2)呈负相关,与PCO_( 2)、APACHEⅡ评分呈正相关(P<0.05,P<0.01)。随访1年后共死亡31例(46.97%)。AECOPD合并Ⅱ型呼吸衰竭死亡患者BNP、HCAR、D-D高表达率明显高于生存患者(P<0.05,P<0.01)。合并多种器官功能障碍、BNP(高表达)、HCAR(高表达)、D-D(高表达)是影响AECOPD合并Ⅱ型呼吸衰竭患者死亡的独立危险因素(P<0.05,P<0.01)。结论AECOPD合并Ⅱ型呼吸衰竭患者BNP、HCAR、D-D水平呈异常增高状态,三者与患者的病情呈显著相关性,也可作为评估预后的敏感性指标。

Objective To explore changes of brain natriuretic peptide(BNP),hypersensitive C-reactive protein/albumin ratio(HCAR)and D-Dimer(DD)levels in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with typeⅡrespiratory failure and their correlations with pathogenetic conditions and prognosis.Methods A total of 138 AECOPD patients admitted during May 2017 and September 2019 were selected and divided into AECOPD combined with typeⅡrespiratory failure group(n=66)and AECOPD without typeⅡrespiratory failure group(n=72)according to whether or not having typeⅡrespiratory failure.Levels of BNP,HCAR and D-D were compared,and correlations between the three indicators and lung function related indexes of AECOPD patients combined with typeⅡrespiratory failure were analyzed.Risk factors affected the death of AECOPD patients with typeⅡrespiratory failure were analyzed.Results In AECOPD combined with typeⅡrespiratory failure group,values of BNP,HCAR,DD,partial pressure of carbon dioxide(PCO_( 2)),acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores were significantly higher,while values of percentage of forced expiratory volume in the first second to predicted value(FEV1%),forced expiratory volume in the first second/forced vital capacity(FEV1/FVC)and oxygen partial pressure(PO_( 2))were significantly lower than those in AECOPD without typeⅡrespiratory failure group(P<0.01).Levels of BNP,HCAR and D-D in AECOPD patients with typeⅡrespiratory failure were negatively correlated with FEV1%,FEV1/FVC and PO_( 2),and the levels were positively correlated with PCO_( 2) and APACHEⅡscores(P<0.05,P<0.01).After the patients were followed up for 1 year,and 31 patients(46.97%)died.The high expression rates of BNP,HCAR and D-D in dead patients with AECOPD combined with typeⅡrespiratory failure were significantly higher than those of surviving patients(P<0.05,P<0.01).Combined multiple organ dysfunctions,BNP(high expression),HCAR(high expression)and D-D(high expression)were independent risk factors affecting the death of AECOPD patients with typeⅡrespiratory failure(P<0.05,P<0.01).Conclusion Levels of serum BNP,HCAR and D-D in patients with AECOPD combined with type II respiratory failure are abnormally increased,which are significantly correlated with pathogenetic conditions,and they can be used as sensitive indicators in evaluation of prognoses of patients.