氨基末端脑钠肽前体与慢性阻塞性肺疾病患者心肺功能相关性及对生命质量影响

Correlation between amino-terminal brain natriuretic peptide precursor and cardiopulmonary function in chronic obstructive pulmonary disease patients and impact on quality of life

目的:探讨NT-proBNP对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)不同发病时期的诊断价值,分析其与患者心肺功能相关性及其对生命质量的影响。方法:选取2019年9月至2022年10月本院收治的200例COPD患者进行前瞻性研究,根据6个月内是否发生急性加重分为急性加重组(n=80)、稳定组(n=120),并选取同期体检中心100例健康人群作为健康组。比较各组NT-proBNP水平。采用受试者工作特征曲线(ROC)分析NT-proBNP对COPD稳定期、急性加重期的诊断价值。根据NT-proBNP水平分为正常组、升高组。比较两组社会人口学资料、心功能[LAD、LVEDD、LVEF、右心房内径(right atrial internal diameter,RAD)、LVESD]、肺功能(FEV_(1)/FVC)。应用Pearson分析NT-proBNP与心肺功能及生命质量的相关性。结果:急性加重组NTproBNP水平高于稳定组、健康组,且稳定组高于健康组(P<0.05);NT-proBNP诊断COPD稳定期、急性加重期的AUC分别为0.828、0.806;NT-proBNP水平升高组FEV_(1)/FVC、LVEF、SF-36评分低于正常组,LAD、LVEDD、RAD、LVESD高于正常组(P<0.05);NT-proBNP与FEV_(1)/FVC、LVEF呈负相关(r=-0.854、-0.823,均P<0.001),与LAD、LVEDD、RAD、LVESD、SF-36评分呈正相关(r=0.788、0.728、0.829、0.769、-0.818,均P<0.001)。结论:COPD急性加重期患者血浆NTproBNP水平升高,且与心肺功能有关,其对COPD不同发病时期具有一定诊断价值,可能作为评估患者生命质量的临床指标。

Objective:To investigate the diagnostic value of NT-proBNP in different periods of chronic obstructive pulmonary disease(COPD),and to analyze its correlation with patients'cardiopulmonary function and its impact on quality of life.Methods:A total of 200 COPD patients admitted to our hospital from September 2019 to October 2022 were selected for prospective study,and were divided into acute plus group(80 cases)and stable group(120 cases)according to whether acute exacerbation occurred within 6 months,and 100 healthy people from the medical check-up centre during the same period were selected as the healthy group.The NT-proBNP levels of each group were compared.The diagnostic value of NT-proBNP for stable and acute exacerbation of COPD was analyzed using the subject operating characteristic curve (ROC). The groups were divided into normal and elevated groups according to NT-proBNP levels. The socio-demographic data, cardiac function [LAD, LVEDD, LVEF, right atrial internal diameter (RAD), LVESD], and pulmonary function [ratio of exertional expiratory volume in the first second to exertional lung volume (FEV_(1)/FVC)] were compared between the two groups. Pearson analysis was applied to correlate NT-proBNP with cardiopulmonary function and quality of life. Results: Acute plus recombinant NT-proBNP levels were higher than those in the stable and healthy groups, and the stable group was higher than the healthy group (P<0.05);the AUCs of NT-proBNP for diagnosing stable COPD and acute exacerbation were 0.828 and 0.806, respectively;FEV_(1)/FVC, LVEF, and SF-36 scores were lower in the group with elevated NT-proBNP levels than in the normal group. LAD, LVEDD, RAD, and LVESD were higher than the normal group (P<0.05). NT-proBNP was negatively correlated with FEV_(1)/FVC and LVEF (r=-0.854, -0.823, both P<0.001) and positively correlated with LAD, LVEDD, RAD, LVESD, and SF-36 scores (r=0.788, 0.728, 0.829, 0.769, -0.818, all P<0.001). Conclusions: Plasma NT-proBNP levels are elevated in patients with acute exacerbation of COPD and are associated with cardiopulmonary function, which has a diagnostic value for different periods of COPD onset and may be used as a clinical indicator to assess patients' quality of life.