B型钠尿肽和N末端B型钠尿肽前体对老年慢性阻塞性肺疾病合并心力衰竭的诊断价值

Diagnostic value of BNP and NT-proBNP for chronic obstructive pulmonary disease complicated with heart failure in the elderly

目的 探讨和分析外周血B型钠尿肽(brain natriuretic peptide, BNP)、N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide, NT-proBNP)水平变化与老年慢性阻塞性肺疾病(chronic obstructive pulmoriary disease, COPD)合并心力衰竭(heart failure, HF)的关系。方法 选取2021年4月至2023年8月武汉市第一医院收治的老年COPD患者210例,根据是否合并HF分为COPD合并HF组61例与COPD组149例。采用免疫荧光法检测所有患者外周血BNP、NT-proBNP水平,所有患者均行常规超声心动图检测左心室射血分数(left ventricular ejection fraction, LVEF)、左心室收缩末期内径(left ventricular end-systolic diameter, LVESD)、左心室舒张末期内径(left ventricular end-diastolic diameter, LVEDD),采用Pearson相关性分析评价外周血BNP、NT-proBNP水平与心功能之间的关系,采用多因素logistic回归分析老年COPD合并HF的危险因素,ROC曲线分析外周血BNP、NT-proBNP对老年COPD患者合并HF的诊断价值。结果 COPD合并HF组BNP、NT-proBNP、LVESD、LVEDD显著高于COPD组,LVEF显著低于COPD组(P<0.01)。BNP、NT-proBNP、LVEF、LVEDD是COPD患者合并HF的独立影响因素(P<0.05,P<0.01)。外周血BNP预测COPD患者合并HF的敏感性为82.0%,特异性为94.6%,曲线下面积(area under curve, AUC)为0.802(95%CI:0.712~0.892);外周血NT-proBNP预测COPD患者合并HF的敏感性为88.5%,特异性为92.6%,AUC为0.823(95%CI:0.767~0.879)。COPD合并HF患者外周血BNP、NT-proBNP水平与LVEF呈负相关(r=-0.413,P=0.013;r=-0.521,P=0.000),与LVESD(r=0.356,P=0.010;r=0.565,P=0.000)、LVEDD(r=0.335,P=0.014;r=0.501,P=0.000)及纽约心脏病协会心功能分级呈正相关(r=0.687,P=0.000;r=0.752,P=0.000)。结论 外周血BNP、NT-proBNP高水平与老年COPD患者合并HF相关,与心功能分级存在关系,对于COPD患者的HF程度评估具有重要价值。

Objective To explore and analyze the relationship between the peripheral blood changes in BNP and NT-proBNP levels and the complication of chronic obstructive pulmonary disease(COPD) and heart failure(CHF) in the elderly.Methods A total of 210 elderly COPD patients admitted to our hospital from April 2021 to August 2023 were enrolled, and according to complication with HF or not, they were divided into COPD+HF group(61 cases) and COPD group(149 cases).Immunofluorescence assay was used to detect the expression levels of BNP and NT-proBNP in the peripheral blood samples of all patients.Routine echocardiography was applied to detect left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),and left ventricular end-diastolic diameter(LVEDD).Pearson correlation analysis was used to evaluate the correlation between peripheral blood BNP and NT-proBNP expression and cardiac function.Multivariate regression analysis was conducted to analyze the independent influencing factors of COPD complicated with HF,and ROC curves were drawn to evaluate the predictive value of peripheral blood BNP and NT-proBNP levels for COPD complicated by HF.Results The BNP,NT-proBNP,LVESD and LVEDD were significantly higher and the LVEF was obviously lower in COPD+HF group than the COPD group(P<0.01).BNP,NT-proBNP,LVEF,and LVEDD were risk factors for COPD complicated with HF(P<0.05,P<0.01).The sensitivity, specificity, and AUC value of BNP in predicting the complication were 82.0%,94.6%,and 0.802(95%CI:0.712-0.892),and those of NT-proBNP in the prediction were 88.5%,92.6%,and 0.823(95%CI:0.767-0.879),respectively.In the COPD patients complicated with HF,the NT-proBNP and BNP levels in the peripheral blood were negatively correlated with LVEF(r=-0.413,P=0.013;r=-0.521,P=0.000),and positively with LVESD(r=0.356,P=0.010;r=0.565,P=0.000),LVEDD(r=0.335,P=0.014;r=0.501,P=0.000) and NYHA cardiac function grades(r=0.687,P=0.000;r=0.752,P=0.000).Conclusion The high levels of BNP and NT-proBNP in peripheral blood are closely associated with COPD complication with HF,and are related to cardiac function grade, which is of great value for the evaluation of HF severity in COPD patients.