慢性阻塞性肺部疾病合并充血性心力衰竭患者B型脑钠肽的变化及临床意义

目的探讨慢性阻塞性肺部疾病（COPD）合并充血性心力衰竭（CHF）患者血浆B型脑钠肽（BNP）水平的变化及临床意义。方法选择120例COPD患者作为研究对象，其中COPD合并CHF组54例，COPD急性发作（AECOPD）组66例，选择健康体检正常者36例作为对照组，采用免疫荧光法快速测定BNP水平。比较三组间血浆BNP水平的差异。COPD合并CHF患者治疗好转后复查血浆BNP水平，比较治疗前、后血浆BNP水平的变化。结果COPD合并CHF组和AECOPD组血浆BNP水平分别为（798．41±231．64）pg／ml和（148．73±87．39）pg／ml；对照组血浆BNP水平为（46．83±15．54）pg／ml。COPD合并CHF患者与对照组及AECOPD患者比较，血浆BNP水平差异均有统计学意义（P〈0．01）；治疗后血浆BNP水平（136．73±64．82）pg／ml]与治疗前比较明显下降（P〈0．01）。结论血浆BNP水平测定对COPD合并CHF患者有重要的鉴别诊断价值，可作为COPD合并CHF患者治疗效果的评价指标。

The change and clinical value of the plasma level of B-type natriuretic peptide in chronic obstructive pulmonary disease combined with congestive heart failure

Objective To investgate the change of the plasma level of B-type natriuretic peptide in chronic obstructive pulmonary disease combined with congestive heart failure and its clinical significance. Methods Patients with COPD were divided into two groups： one with congestive heart failure and another with acute exacerbations of COPD. 36 healthy peoples were ehoosed as the control group. Plasma BNP levels were measured with fluorescence immunoassay. To compare the levies of BNP, the plasma BNP levels were remeasured when CHF were controled. Results The plasma levels of BNP in patients with congestive heart failure （798.41±231.64）pg/ml were significantly higher than those in patients with acute exacerbations of COPD （148.73±87.39）pg/ml and controls（46.83±15.54）pg/ml（both P〈0.01 ）. The plasma levels of BNP in patients with congestive heart failure post-therapy （136.73±64.82）pg/m] were significantly lower than pre-therapy （P〈0.01）. Conclusion The assay of plasma BNP concentration is useful in differential diagnosis in chronic obstructive pulmonary disease combined with congestive heart failure, and could be used to evaluating the therapeutic effect.