血小板计数及N-末端脑钠肽前体等实验室指标在结缔组织病伴发肺动脉高压中的临床意义  

Clinical significance of platelet count,N-terminal pro-brain natriuretic peptide and other laboratory parameters in connective tissue diseases complicated with pulmonary hypertension

作　　者：李园园[1] 胡克[1] 

机构地区：[1]武汉大学人民医院呼吸科,湖北武汉430060

出　　处：《中华实用诊断与治疗杂志》2016年第3期228-230,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81070065);国家自然科学基金(81370181)

摘　　要：目的探讨血小板计数(platelet count,PLT)、N-末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NTproBNP)、乳酸脱氢酶(lactate dehydrogenase,LDH)及pa(O_2)水平变化在结缔组织病(connective tissue disease,CTD)相关肺动脉高压(pulmonary hypertension,PH)中的临床意义。方法 CTD患者69例,采用心脏超声测定肺动脉压力,其中47例单纯CTD患者为CTD组,22例CTD伴PH者为CTD-PH组。检测2组外周血PLT、NT-proBNP、血清LDH水平及动脉血pa(O_2),并进行比较。结果 CTD-PH组系统性红斑狼疮患者12例,混合性CTD患者5例,系统性硬化症患者2例,原发性干燥综合征患者2例,类风湿性关节炎患者8例;CTD-PH组轻中度患者12例,重度患者10例;CTD-PH组患者NT-proBNP[4 846.5(3 817.0,5 888.5)ng/L]、血清LDH[529.0(407.3,597.5)u/L]水平高于CTD组[871.0(479.0,1 215.0)ng/L、198.0(175.0,228.0)u/L],PLT[147.5(97.8,193.0)×109]和动脉血pa(O_2)[7.0(5.6,9.4)kPa]水平低于CTD组[197.0(150.0,248.0)×109、11.1(10.4,12.0)kPa](P<0.05);重度CTD-PH患者NT-proBNP[5 839.0(5 617.0,6 278.5)ng/L]、血清LDH水平[592.0(562.0,654.5)u/L]高于轻中度患者[4 164.5(3 017.0,4 710.5)ng/L、424.5(286.8,513.0)u/L],pa(O_2)[5.7(4.6,6.3)kPa]低于轻中度患者[9.2(7.3,9.6)kPa](P<0.05);NT-proBNP、血清LDH水平与pa(O_2)呈负相关(r=-0.948,P=0.000;r=-0.946,P=0.000)、与PH严重程度呈正相关(r=0.804,P=0.000;r=0.774,P=0.000);PLT与PH严重程度无明显相关性(r=-0.267,P=0.229)。结论不同CTD患者PH发病率不同,系统性红斑狼疮和混合性CTD患者PH发病率较高;CTD-PH患者PLT、NT-proBNP、血清LDH和pa(O_2)水平有明显变化,并与病情严重程度有相关性,可作为临床评估CTD-PH病情的指标。Objective To investigate the clinical significance of platelet count （PLT）, N-terminal pro-brain natriuretic peptide （NT-proBNP）, serum lactate dehydrogenase （LDH） and pa （O2） levels in connective tissue diseases （CTD） complicated with pulmonary hypertension （PH）. Methods Sixty-nine patients with CTD were measured pulmonary pressure by Doppler echocardiography, in which 47 patients were not complicated with PH （CTD group） and 22 were complicated with PH （CTD-PH group）. The levels of PLT, NT-proBNP, serum LDH and pa（O2） were detected and compared between two groups. Results In CTD-PH group, systemic lupus erythematosus occurred in 12 patients, mixed CTD in 5, systemic sclerosis in 2, primary Sj-gren＇s syndrome in 2 and rheumatoid arthritis in 8. There were 12 mild and moderate PH and 10 severe PH patients in CTI-PH group. The levels of NT-proBNP （4 846. 5 （3 817. 0, 5 888. 5） ng/L） and serum LDH （529. 0 （407. 3, 597. 5） u/L） in CTD-PH group were significantly higher than those in CTD group （（871.0 （479.0, 1 215.0） ng/L, 198.0 （175.0, 228.0） u/L）, and the levels of PLT （147.5 （97.8, 193.0） X109 and pa（O2） （（7.0 （5.6, 9.4） kPa） in CTD-PH group were significantly lower than those in CTD group （197.0（150.0, 9.48.0） X 109 , 11.1 （10.4, 12.0） kPa） （P（0.05）. The levels of NT-proBNP （5 839.0 （5 617.0, 6 278.5） ng/L） and serum LDH （592.0 （562.0, 654.5） u/L） were significantly higher in severe PH patients than those in mild and moderate PH patients （4 164.5 （3 017.0, 4 710. 5） ng/L, 424. 5 （286. 8, 513. 0） u/L） in CTD-PH group, and pa（O2） was significantly lower in severe PH patients （5.7 （4.6, 6.3） kPa） than that in mild and moderate PH patients （9.2 （7.3, 9.6） kPa） （P（0.05）. NT-proBNP and LDH were negatively correlated with pa （O2） （r=- 0. 948, P= 0. 000;r=--0. 946, P= 0. 000）, were positively correlated with the severity of PH （r=0. 804, P= 0. 000; r= 0.

关 键 词：结缔组织病 肺动脉高压 血小板计数 N-末端脑钠肽前体 乳酸脱氢酶 pa(O2) 

分 类 号：R544.1[医药卫生—心血管疾病] R593.2[医药卫生—内科学]