慢性肺源性心脏病急性加重期患者血浆骨膜蛋白、内皮素-1、N端脑钠肽前体的表达及意义
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摘要
目的通过分析血浆骨膜蛋白(periostin)、内皮素-1(ET-1)、N端脑钠肽前体(NT-proBNP)水平变化,探讨三者变化对慢性肺源性心脏病急性加重期的临床监测价值及意义。方法选取研究对象为2015年12月至2018年3月于华北理工大学附属医院呼吸内科门诊及住院的慢性肺源性心脏病患者(所有入组患者均为慢性阻塞性肺疾病导致)。其中A组(慢性肺源性心脏病急性加重期)患者34例,B组(慢性肺源性心脏病稳定期)患者30例,C组(COPD)患者30例,健康体检组42例。所有入组人群均完善血气分析、心脏超声、肺功能等检查,并对临床基本资料进行对比。均完善血浆periostin、ET-1、NT-proBNP表达水平检测,分析血浆periostin、ET-1、NT-proBNP与血气分析的相关性。结果通过对COPD患者导致的慢性肺源性心脏病对比发现,各组患者的性别、年龄、体质指数(BMI)及吸烟指数等指标相比,差异无统计学意义(P>0.05)。通过比较各组家庭氧疗情况,发现C组患者较A、B组患者家庭氧疗时间长。血气分析对比发现A、B、C三组PO2均较体检组水平低,并且A组较B、C组更低,差异有统计学意义(P<0.05),而B组与C组PO2比较水平,差异无统计学意义(P>0.05);PCO2比较,A、B、C三组明显高于体检组,差异有统计学意义(P<0.05);并且A组较B组高,B组较C组PCO2水平高,差异有统计学意义(P<0.05)。对比发现A、B、C三组患者血浆periostin、ET-1、NT-proBNP的表达水平高于体检组,并且A组较B、C组表达水平高,B组血浆periostin、NT-proBNP较C组表达升高,差异有统计学意义(P<0.05)。而B、C组患者ET-1比较表达水平无明显变化,差异无统计学意义(P>0.05)。通过Pearson相关分析,发现PO2与血浆periostin、ET-1、NT-proBNP呈负相关,PCO2与血浆periostin、ET-1、NT-proBNP呈显著正相关。结论通过本研究发现血浆periostin、ET-1、NT-proBNP在慢性肺源性心脏病急性加重期随病情加重有明显升高趋势,为临床医师对肺源性心脏病患者早期评价及干预提供一定参考价值。
Objective To discuss the value and significance of clinical monitoring of level changes of plasma periostin, endothelin-1(ET-1) and N-terminal pro-brain natriuretic peptide(NT-proBNP) during acute exacerbation of chronic pulmonary heart disease(CPHD). Methods CPHD patients(induced by COPD) were chosen from Department of Respiratory Medicine in Affiliated Hospital of North China University of Science and Technology from Dec. 2015 to Mar. 2018. The patients were divided into group A(acute exacerbation of CPHD,n=34), group B(stable stage of CPHD, n=30) and group C(COPD, n=30), and cases of physical examination(n=42)were chosen into control group. The examinations of blood gas analysis, cardiac echocardiogram and lung function were completed, and general clinical data was compared in all groups. The expressions of plasma periostin, ET-1 and NT-proBNP were detected, and correlation among periostin, ET-1, NT-proBNP and blood gas analysis was analyzed. Results The comparison in indexes of sex, age, BMI and smoking index had no statistical difference among all groups(P>0.05) through compared CPHD induced by COPD. The time of home oxygen therapy was longer in group C than that in group A and group B through compared home oxygen therapy among all groups. The results of blood gas analysis showed that PO2 level was lower in groups A, B and C than that in control group, and it was much lower in group B and C than that in group C(P<0.05). The level of PO2 had no statistical difference between group B and group C(P>0.05). The level of PCO2 was significantly higher in groups A, B and C than that in control group(P<0.05), and was higher in group A than that in group B and was higher in group B than that in group C(P<0.05). The expressions of plasma periostin, ET-1 and NT-proBNP were higher in groups A, B and C than those in control group, and were higher in group A than those in group B and group C. The expressions of plasma periostin and NT-proBNP were higher in group B than those in group C(P<0.05). The expression of plasma ET-1 had no significant changes in group B and group C(P>0.05). The results of Pearson correlation analysis showed that PO2 was negatively correlated to plasma periostin, ET-1 and NT-proBNP, and PCO2 was greatly positively correlated to plasma periostin, ET-1 and NT-proBNP. Conclusion The levels of plasma periostin, ET-1 and NTproBNP have significant increasing trend during acute exacerbation of CPHD, which has some reference value to physicians in early reviewing and intervening in CPHD patients.
Objective To discuss the value and significance of clinical monitoring of level changes of plasma periostin, endothelin-1(ET-1) and N-terminal pro-brain natriuretic peptide(NT-proBNP) during acute exacerbation of chronic pulmonary heart disease(CPHD). Methods CPHD patients(induced by COPD) were chosen from Department of Respiratory Medicine in Affiliated Hospital of North China University of Science and Technology from Dec. 2015 to Mar. 2018. The patients were divided into group A(acute exacerbation of CPHD,n=34), group B(stable stage of CPHD, n=30) and group C(COPD, n=30), and cases of physical examination(n=42)were chosen into control group. The examinations of blood gas analysis, cardiac echocardiogram and lung function were completed, and general clinical data was compared in all groups. The expressions of plasma periostin, ET-1 and NT-proBNP were detected, and correlation among periostin, ET-1, NT-proBNP and blood gas analysis was analyzed. Results The comparison in indexes of sex, age, BMI and smoking index had no statistical difference among all groups(P>0.05) through compared CPHD induced by COPD. The time of home oxygen therapy was longer in group C than that in group A and group B through compared home oxygen therapy among all groups. The results of blood gas analysis showed that PO2 level was lower in groups A, B and C than that in control group, and it was much lower in group B and C than that in group C(P<0.05). The level of PO2 had no statistical difference between group B and group C(P>0.05). The level of PCO2 was significantly higher in groups A, B and C than that in control group(P<0.05), and was higher in group A than that in group B and was higher in group B than that in group C(P<0.05). The expressions of plasma periostin, ET-1 and NT-proBNP were higher in groups A, B and C than those in control group, and were higher in group A than those in group B and group C. The expressions of plasma periostin and NT-proBNP were higher in group B than those in group C(P<0.05). The expression of plasma ET-1 had no significant changes in group B and group C(P>0.05). The results of Pearson correlation analysis showed that PO2 was negatively correlated to plasma periostin, ET-1 and NT-proBNP, and PCO2 was greatly positively correlated to plasma periostin, ET-1 and NT-proBNP. Conclusion The levels of plasma periostin, ET-1 and NTproBNP have significant increasing trend during acute exacerbation of CPHD, which has some reference value to physicians in early reviewing and intervening in CPHD patients.
引文
[1]李广斌.慢性肺源性心脏病发病机制及治疗靶点研究进展[J].天津医科大学学报,2014,20(2):162-4.
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[7]胡洋洋,赵晓燕.NT-proBNP下降率与急性心力衰竭患者预后的研究[J].中国循证心血管医学杂志,2018,10(6):682-4.
[8]祖晓麟,曾玉杰,张锋,等.重组人脑钠肽对老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者预后的影响[J].中国医药,2018,13(8):1141-4.
[9]陈令东,顾鹏.急诊室脑钠肽测定在呼吸困难鉴别诊断中的应用[J].实用医学杂志,2012,28(21):3568-70.
[10]吕宗军.血浆NT-proBNP对慢性阻塞性肺疾病合并肺心病的鉴别诊断价值[J].心脑血管病防治,2014,14(5):403-5.
[11]杜伟.血浆脑钠肽水平在慢性肺源性心脏病诊断中的临床意义[J].中国循证心血管医学杂志,2017,(5):591-3.
[12]Yanagisawa M,Kurihara H,Kimura S,et al.A novel potent vasoconstrictor peptide produced by vascular endothelial cells[J].Nature,1988,332(6163):411-5.
[13]高彩丽,叶武成.瑞舒伐他汀治疗慢性心力衰竭的临床疗效及其对内皮素和炎性因子的影响[J].实用心脑肺血管病杂志,2015,23(10):58-60.
[14]Davenport AP,Hyndman KA,Dhaun N,et al.Endothelin[J].Pharmacol Rev,2016,68(2):357-418.
[15]Conway SJ,Izuhara K,Kudo Y,et al.The role of periostin in tissue remodeling across health and disease[J].Cell Mol Life Sci,2014,71(7):1279-88.
[16]Spinale FG.Myocardial matrix remodeling and the matrix metalloproteinases:influence on cardiac form and function[J].Physiol Rev,2007,87(4):1285-342.
[17]Takeda N,Manabe I.Cellular Interplay between Cardiomyocytes and Nonmyocytes in Cardiac Remodeling[J].Int J Inflam,2011,2011:535241.
[18]Urashima T,Zhao M,Wagner R,et al.Molecular and physiological characterization of RV remodeling in a murine model of pulmonary stenosis[J].Am J Physiol Heart Circ Physiol,2008,295(3):H1351-H1368.
[19]魏大闯,肖学钧.肺动脉高压与右心室重构的关系[J].心血管病学进展,2013,34(5):648-51.
[20]罗辉遇,李奕华,胡燕怡,等.肺源性心脏病急性加重期凝血状态与动脉血气的相关性及预后影响分析[J].广东医学,2016,37(2):221-3.
[21]阮景昊,周甲东,万崇华,等.慢性肺源性心脏病患者生命质量与临床客观指标的相关性研究[J].中国全科医学,2017,20(1):45-50.
[2]乔人立.重新认识慢性阻塞性肺疾病与肺源性心脏病[J].中华结核和呼吸杂志,2011,34(4):246-8.
[3]张建明,朱锋,牟华明,等.缺血性心力衰竭患者血浆periostin检测的临床意义[J].中国老年学杂志,2013,33(20):5114-5.
[4]陈建丽,徐超,李振华.COPD合并肺动脉高压患者血清NT-proBNP和内皮素-1的表达意义研究[J].重庆医学,2016,45(23):3278-80.
[5]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-64.
[6]卢笛,傅玉娟,廖禹林.骨膜蛋白对心脏重构的作用及其机制[J].广东医学,2011,32(16):2212-4.
[7]胡洋洋,赵晓燕.NT-proBNP下降率与急性心力衰竭患者预后的研究[J].中国循证心血管医学杂志,2018,10(6):682-4.
[8]祖晓麟,曾玉杰,张锋,等.重组人脑钠肽对老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者预后的影响[J].中国医药,2018,13(8):1141-4.
[9]陈令东,顾鹏.急诊室脑钠肽测定在呼吸困难鉴别诊断中的应用[J].实用医学杂志,2012,28(21):3568-70.
[10]吕宗军.血浆NT-proBNP对慢性阻塞性肺疾病合并肺心病的鉴别诊断价值[J].心脑血管病防治,2014,14(5):403-5.
[11]杜伟.血浆脑钠肽水平在慢性肺源性心脏病诊断中的临床意义[J].中国循证心血管医学杂志,2017,(5):591-3.
[12]Yanagisawa M,Kurihara H,Kimura S,et al.A novel potent vasoconstrictor peptide produced by vascular endothelial cells[J].Nature,1988,332(6163):411-5.
[13]高彩丽,叶武成.瑞舒伐他汀治疗慢性心力衰竭的临床疗效及其对内皮素和炎性因子的影响[J].实用心脑肺血管病杂志,2015,23(10):58-60.
[14]Davenport AP,Hyndman KA,Dhaun N,et al.Endothelin[J].Pharmacol Rev,2016,68(2):357-418.
[15]Conway SJ,Izuhara K,Kudo Y,et al.The role of periostin in tissue remodeling across health and disease[J].Cell Mol Life Sci,2014,71(7):1279-88.
[16]Spinale FG.Myocardial matrix remodeling and the matrix metalloproteinases:influence on cardiac form and function[J].Physiol Rev,2007,87(4):1285-342.
[17]Takeda N,Manabe I.Cellular Interplay between Cardiomyocytes and Nonmyocytes in Cardiac Remodeling[J].Int J Inflam,2011,2011:535241.
[18]Urashima T,Zhao M,Wagner R,et al.Molecular and physiological characterization of RV remodeling in a murine model of pulmonary stenosis[J].Am J Physiol Heart Circ Physiol,2008,295(3):H1351-H1368.
[19]魏大闯,肖学钧.肺动脉高压与右心室重构的关系[J].心血管病学进展,2013,34(5):648-51.
[20]罗辉遇,李奕华,胡燕怡,等.肺源性心脏病急性加重期凝血状态与动脉血气的相关性及预后影响分析[J].广东医学,2016,37(2):221-3.
[21]阮景昊,周甲东,万崇华,等.慢性肺源性心脏病患者生命质量与临床客观指标的相关性研究[J].中国全科医学,2017,20(1):45-50.