急性加重期慢性阻塞性肺疾病合并右心衰竭患者B型利钠肽测定的临床意义  

Clinical value of detection of B-type natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease combined with right heart failure

作　　者：黄敏洁 徐俊伟 何琪芳 王林林 王萌 HUANG Minjie;XU Junwei;HE Qifang;WANG Linlin;WANG Meng(Department of Respiratory and Critical Medicine,Jiangyin Hospital Affiliated to Nantong University,Wuxi,Jiangsu,214400;Department of Cardiovascular Medicine,Brain Hospital Affiliated to Nanjing Medical University,Nanjing Chest Hospital,Nanjing,Jiangsu,210029;Department of Critical Care Medicine,Jiangyin Hospital Affiliated to Nantong University,Wuxi,Jiangsu,214400;Emergency Department,the Affiliated Hospital of Nantong University,Nantong,Jiangsu,226001)

机构地区：[1]南通大学附属江阴医院呼吸与危重症医学科,江苏无锡214400 [2]南京医科大学附属脑科医院/南京市胸科医院心血管内科,江苏南京210029 [3]南通大学附属江阴医院重症医学科,江苏无锡214400 [4]南通大学附属医院急诊科,江苏南通226001

出　　处：《实用临床医药杂志》2025年第5期101-105,111,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省自然科学基金青年基金(BK20160134);江苏省江阴市卫生健康委员会青年科研项目(Q202310)。

摘　　要：目的探讨B型利钠肽(BNP)对急性加重期慢性阻塞性肺疾病(AECOPD)合并右心衰竭(RHF)的预测价值。方法选取2022年1月—2024年1月在南通大学附属江阴医院、南京市胸科医院就诊的AECOPD患者为研究对象,根据纳入和排除标准最终纳入122例患者。根据患者是否合并RHF,将其分为观察组(AECOPD合并RHF,n=72)和对照组(AECOPD未合并RHF,n=50)。比较2组各项指标的差异,并通过Logistic回归分析和受试者工作特征(ROC)曲线评估BNP对AECOPD患者合并RHF的预测价值,并采用ROC曲线确定BNP的截断值。结果2组性别、体温、白蛋白、血糖、氯离子、肺动脉压(PAP)、BNP水平差异有统计学意义(P<0.05)。Logistic回归分析结果显示,BNP是AECOPD合并RHF患者的独立预测因子(OR=1.03,95%CI:1.01~1.04,P<0.05)。ROC曲线结果显示,BNP截断值为83.5 pg/mL时,灵敏度为0.820,特异度为0.972,约登指数为0.792。BNP的曲线下面积为0.875(95%CI:0.800~0.949,P<0.001)。当AECOPD患者BNP>83.5 pg/mL时,RHF发病率明显增高。结论AECOPD合并RHF的患者血浆BNP水平高于未合并RHF者,且BNP对于判断AECOPD患者是否合并RHF具有重要的预测价值。Objective To investigate the predictive value of B-type natriuretic peptide(BNP)for acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by right heart failure(RHF).Methods This study selected AECOPD patients admitted to Jiangyin Hospital Affiliated to Nantong University and Nanjing Chest Hospital from January 2022 to January 2024 as objects.According to the inclusion and exclusion criteria,122 patients were ultimately enrolled.The patients were divided into observation group(AECOPD with RHF,n=72)and control group(AECOPD without RHF,n=50)based on whether they had RHF.Differences in various indicators between the two groups were compared,and the predictive value of BNP for AECOPD patients with RHF was assessed through Logistic regression analysis and receiver operating characteristic(ROC)curves.The cut-off value of BNP was determined using the ROC curve.Results Statistically significant differences were observed between the two groups in terms of gender,body temperature,albumin,blood glucose,chloride ions,pulmonary artery pressure(PAP),and BNP levels(P<0.05).Logistic regression analysis showed that BNP was an independent predictor for AECOPD patients with RHF(OR=1.03;95%CI,1.01 to 1.04;P<0.05).The ROC curve results indicated that when the BNP cut-off value was 83.5 pg/mL,the sensitivity was 0.820,the specificity was 0.972,and the Youden index was 0.792.The area under the curve for BNP was 0.875(95%CI,0.800 to 0.949,P<0.001).When the BNP level in AECOPD patients exceeded 83.5 pg/mL,the incidence of RHF significantly increased.Conclusion Patients with AECOPD complicated by RHF have higher plasma BNP levels than those without RHF,and BNP has significant predictive value for determining whether AECOPD patients have RHF.

关 键 词：B型利钠肽 急性加重期 慢性阻塞性肺疾病 右心衰竭 前瞻性研究 LOGISTIC回归分析 

分 类 号：R563[医药卫生—呼吸系统] R540.4[医药卫生—内科学] R446.1[医药卫生—临床医学]