右室心肌工作指数联合NT-proBNP预测COPD相关性肺动脉高压的效能分析  

Predictive Value of Right Ventricular Myocardial Perfomance Index Combined with NT-proBNP in COPD Associated Pulmonary Arterial Hypertension

作　　者：杨梦鸿 辛阿欢 YANG Menghong;XIN Ahuan(The Third Department of Recuperation,Lintong Rehabilitation Center,Xi'an Shaanxi 710600)

机构地区：[1]临潼康复疗养中心疗养三科,陕西西安710600 [2]陕西省汉中市职业技术学院附属医院内三科,陕西汉中723000

出　　处：《医学临床研究》2024年第12期1852-1855,共4页Journal of Clinical Research

摘　　要：【目的】探讨右室心肌工作指数(RVMPI)联合N末端B型利钠肽原(NT-proBNP)对慢性阻塞性肺疾病(COPD)相关性肺动脉高压(PH)的预测价值。【方法】检测144例COPD患者入院24 h内的NT-proBNP、RVMPI及治疗1个月后的肺动脉收缩压(PASP)水平,并根据PASP将患者分为PH组及肺动脉正常组。以Logistic多因素回归分析影响患者继发PH的相关因素,以受试者工作特征(ROC)曲线判定RVMPI及NT-proBNP对患者继发PH的预测价值。【结果】144例患者中,49例有PH(34.03%),95例肺动脉压正常(65.97%)。PH组的吸烟史比例、急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、NT-proBNP及RVMPI均高于正常组,6 min步行距离(6MWD)及第1秒用力呼气容积(FEV_(1))/用力肺活量(FVC)低于正常组(P<0.05)。多因素回归分析显示,吸烟史、6MWD短,APACHEⅡ评分、NT-proBNP及RVMPI表达水平偏高均为COPD患者继发PH的相关因素(P<0.05)。ROC曲线分析显示,NT-proBNP及RVMPI单一及联合预测患者继发PH的曲线下面积(AUC)分别为0.764、0.746、0.854。两者单一预测效能低于两者联合(P<0.05)。【结论】继发PH的COPD患者的NT-proBNP及RVMPI表达水平较高,且其均对PH具有较高的预测效能。【Objective】To explore the predictive value of right ventricular myocardial performance index(RVMPI)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)for chronic obstructive pulmonary disease(COPD)-associated pulmonary arterial hypertension(PH).【Methods】NT-proBNP,RVMPI,and pulmonary artery systolic pressure(PASP)levels were measured in 144 COPD patients within 24 hours of admission and PASP levels were reassessed after one month of treatment.Patients were divided into a PH group and a normal pulmonary artery group based on their PASP levels.Logistic multivariate regression was used to identify factors associated with secondary PH,and receiver operating characteristic(ROC)curves were used to assess the predictive value of RVMPI and NT-proBNP for secondary PH.【Results】Of the 144 patients,49 had PH(34.03%)and 95 had normal pulmonary artery pressure(65.97%).The PH group had a higher proportion of smoking history,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores,NT-proBNP level,and RVMPI level compared to the normal group,while their 6-minute walk distance(6MWD)distance and FEV_(1)/FVC levels were lower(P<0.05).Multivariate regression analysis showed that smoking history,lower 6MWD distance,higher APACHEⅡscores,elevated NT-proBNP level,and increased RVMPI were associated with secondary PH in COPD patients(P<0.05).ROC analysis indicated that the area under the curve(AUC)for predicting secondary PH using NT-proBNP,RVMPI,and their combination were 0.764,0.746,and 0.854,respectively,with the combined prediction being superior to either alone(P<0.05).【Conclusion】COPD patients with secondary PH have elevated NT-proBNP and RVMPI levels,and both markers provide high predictive efficacy for PH.

关 键 词：肺疾病 慢性阻塞性 肺动脉高压 心室功能 右 利钠肽 脑 

分 类 号：R563[医药卫生—呼吸系统]