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B型脑钠肽在左心室射血分数保留的慢性阻塞性肺疾病急性加重期患者中的应用研究

Application of B-type brain natriuretic peptide in patients with acute exacerbation of chronic obstructive pulmonary disease with left ventricular ejection fraction retention

    摘要
  • 摘要:
    目的 分析左心室射血分数（LVEF）保留的慢性阻塞性肺疾病急性加重期（AECOPD）患者血清B型脑钠肽（BNP）与动脉血氧分压pa（O2）、超敏C反应蛋白（hs-CRP）、右心室舒张末期横径（RVDD）及预后死亡的相关性。
    方法 回顾性分析150例LVEF保留的AECOPD患者病例资料，根据血清BNP水平分为A组（BNP≤100 pg/mL，n=82）、B组（BNP>100~400 pg/mL，n=45）、C组（BNP>400 pg/mL，n=23）。比较入院后3组患者pa（O2）、BNP、hs-CRP及RVDD水平。分析BNP与pa（O2）、hs-CRP、RVDD的相关性；采用Logistic回归分析探讨1年内死亡预测因素。统计3组患者1年内的死亡危险比（RR）。
    结果  B组、C组pa（O2）低于A组，BNP、hs-CRP、RVDD高于A组，差异有统计学意义（P < 0.05）；C组BNP、hs-CRP高于B组，差异有统计学意义（P < 0.05）。相关性分析显示，BNP与pa（O2）呈负相关（r=-0.385，P < 0.001），与hs-CRP、RVDD呈正相关（r=0.664、0.388，P < 0.001）；1年内，C组与A组、B组的RR及95%CI分别为1.303（1.019~1.668）、1.263（0.978~1.630），差异有统计学意义（P < 0.05）。BNP是患者1年内死亡的独立预测因素（P < 0.05）。
    结论  LVEF保留的AECOPD患者血清BNP水平升高与pa（O2）降低、hs-CRP升高及RVDD增大有关。血清BNP是评估AECOPD病情及预后死亡的敏感指标。

     

    Abstract:
    Objective  To analyze the correlations of serum B-type brain natriuretic peptide (BNP) with arterial partial pressure of oxygenpa(O2), high-sensitivity C-reactive protein (hs-CRP), right ventricular end diastolic diameter (RVDD) and death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and left ventricular ejection function (LVEF) preservation.
    Methods  The data of 150 AECOPD patients with LVEF preservation were retrospectively analyzed. According to the serum BNP level, they were divided into group A (BNP ≤ 100 pg/mL, n=82), group B (BNP>100 pg/mL to 400 pg/mL, n=45) and group C (BNP>400 pg/mL, n=23). The pa(O2), BNP, hs-CRP and RVDD were compared among the three groups after admission. The correlations of BNP with pa(O2), hs-CRP as well as RVDD were analyzed; predictors of death within 1 year were analyzed by Logistic regression. The 1 year mortality risk ratio (RR) of the 3 groups was analyzed.
    Results  The pa(O2) in group B and group C was significantly lower than that in group A, and BNP, hs-CRP and RVDD were higher than those in group A (P < 0.05). BNP and hs-CRP in group C were significantly higher than those in group B (P < 0.05). Correlation analysis showed that BNP was negatively correlated with pa(O2) (r=-0.385, P < 0.001), but positively correlated with hs-CRP and RVDD (r=0.664, 0.388, P < 0.001). Within 1 year, the RR and 95%CI of group C with group A and group B were 1.303(1.019 to 1.668) and 1.263(0.978 to 1.630), respectively, and the differences were statistically significant (P < 0.05). BNP was an independent predicting factor for death within 1 year (P < 0.05).
    Conclusion  The elevated BNP level in AECOPD patients with LVEF preservation is associated with decreased pa(O2) level, increased hs-CRP, and increased RVDD. Serum BNP is a sensitive indicator for assessing the condition of AECOPD and death.

     

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