脑钠肽在慢性阻塞性肺疾病患者中临床意义的系统评价

目的系统评价脑钠肽(BNP)在慢性阻塞性肺疾病(COPD)患者中的临床意义。方法计算机检索PubMed、Cochrane Library、OVID、CNKI、CBM、VIP、万方等数据库,全面收集BNP与COPD的相关文献,按照Cochrane系统评价手册推荐的方法对纳入研究的文献进行评价,对符合纳入标准的随机对照试验应用RevMan 5.1软件进行Meta分析。结果共纳入9个随机对照试验916例患者。Meta分析结果显示:①COPD患者BNP与健康人比较差异有统计学意义(SMD=0.82,95%CI=0.58~1.07,P0.01),②COPD合并肺心病稳定期患者与单纯COPD患者BNP比较差异有统计学意义(MD=38.32,95%CI=25.95~50.70,P0.01)。③COPD合并肺心病患者稳定期与急性期BNP比较差异有统计学意义(MD=131.96,95%CI=118.91~145.02,P0.01)。④各级COPD患者之间BNP比较差异均有统计学意义(P0.01)。结论随着COPD患者病情加重,血浆中BNP呈升高趋势。BNP对COPD患者的诊断、治疗及预后有重要临床意义。

Systematic review on clinical significance of brain natriuretic peptide in patients with chronic obstructive pulmonary disease

Objective To evaluate the clinical significance of brain natriuretic peptide（BNP）in patients with chronic obstructive pulmonary disease（COPD）.Methods PubMed,Cochrane Library,OVID,CNKI,CBM,VIP,wanfangdata and other databases were searched to get a comprehensive collection of literature about BNP and COPD,then the literature would be evaluated according to the evaluation method of Cochrane systematic review manual and adopted RevMan5.1Meta-analysis software for Meta-analysis.Results Nine randomized controlled trials（RCTs）were included in the final analysis,consisting of 916patients.Meta-analysis showed the results.①The difference of BNP between COPD patients and healthy people was statistically significant（SMD =0.82,95%CI =0.58-1.07,P〈 0.01）.②The difference of BNP between COPD patients with pulmonary heart disease in the plateau stage and patients with COPD was statistically significant（MD =38.32,95%CI =25.95-50.70,P〈 0.01）.③ The difference of BNP between COPD patients with pulmonary heart disease in acute phase and stable phase was statistically significant（MD =131.96,95%CI =118.91-145.02,P 〈0.01）.④ The difference of plasma BNP levels in patients with different degrees of COPD also showed significant difference.Conclusion Plasma BNP increases gradually with the deterioration of COPD.BNP has important clinical significance in diagnosis,treatment and prognosis of COPD patients.