COPD合并PH患者CRP、BNP、ET-1与患者病情及心脏结构的关系

The relationship between CRP,BNP,ET-1 and disease condition and heart structure in patients with COPD complicated with PH

目的探讨慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者血清C反应蛋白(CRP)、B型脑钠肽(BNP)、内皮素-1(ET-1)的变化与患者肺动脉收缩压(PASP)、心脏结构的关系。方法选择2017年4月—2018年8月本院确诊的180例COPD患者作为研究对象,按其是否合并PH分为观察组(COPD合并PH患者)和对照组(单纯COPD患者)两组,每组各90例。检测两组患者的血清CRP、BNP、ET-1水平、PASP、收缩末期右心室内径、左心室内径、左室射血分数(LVEF%),并分析CRP、BNP、ET-1水平与PASP及心脏结构指标的关系。结果两组患者的CRP水平比较,差异无统计学意义(P>0.05);观察组患者的BNP、ET-1水平显著高于对照组,差异具有统计学意义(P<0.05);两组患者的LVEF%值比较,差异无统计学意义(P>0.05);观察组患者的PASP水平、右心室内径/左心室内径显著高于对照组,差异具有统计学意义(P<0.05);三组轻度、中度、重度肺动脉高压患者的CRP水平比较,差异无统计学意义(P>0.05);三组轻度、中度、重度肺动脉高压患者的BNP、ET-1水平组间呈增高趋势,组间两两比较差异均具有统计学意义(P<0.05);COPD合并肺动脉高压(PH)患者的BNP、ET-1与患者PASP、右心室内径/左心室内径呈显著的正相关关系(P<0.05),BNP与患者的LVEF呈显著的负相关关系(P<0.05)。结论COPD合并PH患者BNP、ET-1水平较单纯COPD患者升高显著,并且在一定程度上反映患者肺动脉高压的病情程度、心脏结构的变化。

Objective To explore the relationship between the diversification of serum C-reactive protein(CRP),B-type brain natriuretic peptide(BNP),endothelin-1(ET-1)and pulmonary systolic pressure(PASP)and cardiac structure in patients with chronic obstructive pulmonary disease(COPD)and pulmonary hypertension(PH).Methods The serum CRP,BNP,ET-1,PASP,right ventricular diameter at end-systole,left ventricular diameter,left ventricular ejection fraction(LVEF%)were measured in 90 COPD patients with PH(observation group)and 90 COPD patients(control group)those diagnosed in our hospital from April 2017 to August 2018.The relationship between CRP,BNP,ET-1 levels and PASP and cardiac structural indexes was analyzed.Results There was no significant difference in CRP between the observation group and the control group(P>0.05).The levels of BNP and ET-1 in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in the LVEF%between the observation group and the control group(P>0.05).The levels of PASP,right ventricular diameter/left ventricular diameter in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in CRP among the groups of COPD patients with mild,moderate and severe pulmonary hypertension(P>0.05).The levels of NP and ET-1 showed an increasing trend among the groups,and there was significant difference in pairwise comparisons between groups(P<0.05).BNP and ET-1 in COPD patients with pulmonary hypertension were positively correlated with PASP,right ventricular diameter/left ventricular diameter(P<0.05),and BNP was negatively correlated with LVEF(P<0.05).Conclusions The levels of BNP and ET-1 in patients with COPD and PH were significantly higher than those in patients with COPD alone,and to some extent,they reflects the degree of pulmonary hypertension and the changes of cardiac structure.