N-端脑钠肽前体在慢性阻塞性肺疾病中的变化及意义

目的探讨N_端脑钠肽前体（NT—Pr0BNP）在慢性阻塞}生肺疾病（CDPD）中的变化及意义。方法选择本院收治的68例COPD患者，根据合并肺心病情况，将其分为COPD组与COPD合并肺心病组。COPD合并肺心病组再根据平均肺动脉收缩压（sPAP）分为轻、中、重度肺动脉高压3组。采用全自动免疫荧光分析仪测定患者血浆NT—ProBNP水平，彩色多普勒超声诊断仪进行胸部超声检查，三尖瓣反流法测定肺动脉压。结果COPD合并肺心病组患者血浆NT—ProBNP水平明显高于COPD组，差异有统计学意义，而2组左心室射血分数（LVEF）比较，差异无统计学意义；COPD合并肺心病组患者右心室前壁厚度、右心室舒张末期内径及主肺动脉宽度明显大于COPD组，且肺动脉收缩压显著高于COPD组；NT—ProBNP水平与右心室前壁厚度、右心室舒张末期内径、主肺动脉宽度及肺动脉收缩压呈显著正相关；在轻、中、重度肺动脉高压组患者中NT—ProB—NP水平依次显著升高，组问比较，差异均有统计学意义。结论检测NT—ProBNP水平能较好判断COPD患者右心室功能及肺动脉高压情况，是判断右心室功能损伤严重程度及患者预后较为理想的指标。

Change and significance natriuretic peptide in of N-terminal pro-brain patients with chronic obstructive pulmonary disease

Objective To explore the change and significance of N-terminal pro-brain natri- uretic peptide （NT-ProBNP） in patients with chronic obstructive pulmonary disease （COPD）. Methods 68 patients with COPD were divided into COPD group and COPD with pulmonary heart disease group. The COPD with pulmonary heart disease group was divided into three subgroups ac- cording to level of sPAP, including mild, moderate and severe pulmonary hypertension groups. VI- DAS was used to detect the level of plasma NT-ProBNP, color Doppler ultrasound diagnostic appa- ratus was used to exam the chest and tricuspid regurgitation was used to detect pulmonary hyperten- sion. Results The level ofplasma NT-ProBNP in COPD with pulmonary heart disease group was obviously higher than that in COPD group, but there was no significant difference of left ventricular ejection fraction （LVEF） between two groups. The right ventricular anterior wall thickness and end diastolic internal diameter, main pulmonary width and pulmonary systolic pressure in COPD with pulmonary heart disease group were significantly larger and higher than those in CDPD group, and these were positively associated with the level of NT-ProBNP. The level of NT-ProBNP increased in sequence in mild, moderate and severe pulmonary hypertension groups, and there were significant differences. Conclusion Detection of NT-ProBNP level can reflect the right ventricular function and pulmonary hypertension in patients with COPD, which is an ideal indicator to judge the severe de-gree of right ventricular functional injury and patients＇ prognosis.