慢性阻塞性肺疾病中脑钠肽水平的变化及其临床意义

目的:探讨慢性阻塞性肺疾病(COPD)及慢性肺心病(CCP)患者血浆脑钠肽(BNP)的水平变化及临床意义。方法:将我科住院治疗的COPD患者60例分为单纯COPD组、CCP急性加重期及其缓解期组。CCP患者分别于急性加重期和缓解期测定血浆BNP水平,与单纯COPD组进行比较,并分析其与动脉血氧分压(PO2)、肺动脉收缩压(PAP)和收缩末期右室内径大小及右室/左室内径的相关性。结果:CCP急性加重期血浆BNP水平为262.84±47.59pg/ml,高于缓解期水平[128.52±24.82pg/ml,P<0.01],且两者均高于单纯COPD组[64.76±12.03pg/ml,P?0.01],急性加重期BNP水平与PO2呈负相关(r=-0.654,P?0.01),与PAP呈正相关(r=0.763,P<0.01),而缓解期BNP水平与PO2无显著相关性(P>0.05)。结论:在COPD伴CCP患者中,血浆BNP水平上升,可能与缺氧、肺动脉高压(PAH)等因素相关。

The clinical importance and change of brain natriuretic peptide in diagnosing chronic obstructive pulmonary disease

Objective:To investigate the changes of the levels of plasma brain natriuretic peptide(BNP) in patients with chronic obstructive pulmonary disease(COPD) and chronic cor pulmonale(CCP).Methods:Plasma BNP levels were detected in 30 patients with CCP at acute stage,compared with simple COPD group,and the relationship between it and PO2,pulmonary artery pressure(PAP) was analyzed.Measurements were repeated in the same 30 patients with CCP at remission tage after therapy in hospital.Results:The levels of BNP at acute stage(262.84 ±47.59)pg/ml and remission stage(128.52 ±24.82) pg/ml for CCP group were both higher than that in the simple COPD group(64.76±12.03) pg/ml(P<0.01).Plasma BNP levels were negatively correlated with PO2(r=-0.654,P<0.01) at acute stage,but had no significant correlation at remission stage(P >0.05).In the acute stage of CCP group,BNP levels in the plasma were positively correlated with the PAP(r=0.763,P0.01).Conclusion:Hypoxia and pulmonary artery hypertension may result in elevation of plasma BNP in patients with COPD accompanied with CCP.BNP may involve in the pathophysiological process of CCP.