慢性阻塞性肺疾病合并心功能不全检测氨基末端脑钠肽前体水平的临床意义  

The clinical significance of detection of N-terminal pro-brain natriuretic peptide in COPD patients with heart insufficiency

作　　者：曾雪峰[1] 戴玫[2] 李群[1] 苏娴[1] 陈锋[1] 高蜀生[1] 

机构地区：[1]成都市第三人民医院呼吸科,四川成都610031 [2]成都市第三人民医院心内科,四川成都610031

出　　处：《实用医院临床杂志》2013年第3期67-70,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:090047)

摘　　要：目的观察超声心动图指标和氨基末端脑钠肽前体(NT-Pro-BNP)在慢性阻塞性肺疾病(chronic obstructive pul-monary disease,COPD)合并心功能不全患者中的改变,探讨其临床意义。方法共纳入105例患者,其中COPD合并左心功能不全患者21例(A组),COPD合并右心功能不全28例(B组),COPD合并全心功能不全24例(C组)。选取同期住院不合并心功能不全的COPD患者32例(D组)。4组患者均行超声心动图检查并测定血浆NT-Pro-BNP值,对比各组之间超声心动图指标和血浆NT-Pro-BNP值的差异。结果 A、C组左室射血分数(LVEF)均低于B、D组,B、C组肺动脉压力均高于A、D组,差异均有统计学意义(P<0.01)。A、B、C、D组NT-Pro-BNP水平分别为(1825±418)pg/ml、(746±163)pg/ml、(1936±480)pg/ml和(172±27)pg/ml,各组间比较差异均有统计学意义(P<0.01)。A、C组血浆NT-Pro-BNP水平和LVEF存在负相关(P<0.01);B组血浆NT-Pro-BNP水平和肺动脉压力存在正相关(P<0.01)。结论检测COPD患者血浆BNP有助于诊断患者是否合并心功能不全;血浆NT-Pro-BNP值增高程度与心功能不全的类型有关。Objective To measure the plasma levels of N-terminal pro-brain natriuretic peptide （NT-Pro-BNP） level and ech- ocardiography in patients suffered from chronic obstructive pulmonary disease （COPD） with different types of heart insufficiency, and to assess its value in clinical diagnosis. Methods A total of COPD 105 patients in the same period were divided in to four groups. Group A contained 21 patients with left heart insufficiency. Group B contained 28 patients with right heart insufficiency. Group C contained 24 patients with left and right heart insufficiency. Group D, as acontrol group, contained 32 patients without heart insufficiency. Plasma NT-Pro-BNP was measured and echocardiography was per- formed in the all 105 patients, and compared among the four groups. Results The level of left ventricular ejection fraction （LVEF） in the group A was lower than that in the group B and D, and the level of LVEF in C group was lower than that in the group B and D. The difference was statistically significant. Pulmonary ai＇tery pressure of the group B was higher than that of the group A and D. Pulmonary artery pressure of the group C was higher than that of the group A and D. The difference was statistically significant. There were signifi- cant differences in plasma NT-Pro-BNP levels among the four groups： （ 1825-＋418 ）pg/ml in the Group A, （746-＋ 163 ） pg/ml in the Group B, 1936＋480 pg/ml in the Group C and （ 172-＋27 ） pg/ml in the Group D （P 〈 0.01 ）. There was a negative correlation between plasma BNP levels and LVEF levels in the group A and C （P 〈 0. 01 ） and there was a positive correlation between plasma BNP levels and pulmonary artery pressure in the group B （P 〈 0. 01 ）. Conclusions The detection of plasma BNP may be help for diagnosis of COPD patients with heart insufficiency. The degree of increased plasma level of NT-Pro-BNP is correlated with the type of heart insuffi- ciency.

关 键 词：脑钠肽 慢性阻塞性肺疾病 心功能不全 

分 类 号：R563[医药卫生—呼吸系统] R541.5[医药卫生—内科学]