血清BNP在肺心病和左心衰竭中的比较研究
|
摘要
目的观察血清脑利钠肽(BNP)在慢性肺源性心脏病不同时期及左心衰竭的差异,并与RV、RVOT、LVEF的关系。方法选择对照组(A组)、慢阻肺并肺心病代偿期组(B组)、慢阻肺并肺心病失代偿期组(C组)、单纯左心衰竭组(D组)各100例,检测血清BNP值、肺功能,心彩超,比较各组之间BNP水平与各项指标的差异,并进行相关性分析,绘制不同组ROC曲线,取得最佳截点。结果慢阻肺合并肺心病失代偿期组的BNP值高于代偿期组;左心衰竭组高于慢阻肺合并肺心病失代偿期组。肺心病组的BNP与RV,RVOT,PASP呈正相关,与FEV1呈负相关,与LVEF%无相关性;左心衰组中,BNP与LVEF%呈负相关。慢阻肺并慢性肺心病代偿期组(B组)与慢阻肺并慢性肺心病失代偿期组(C组)的BNP最佳截点为318.7 pg/ml。慢阻肺并慢性肺心病失代偿期组(C组)与单纯左心衰竭组(D组)的BNP最佳截点为784.8 pg/ml。结论在肺心病与左心衰竭患者的BNP水平有不同,且BNP与肺心病病情和临床分期密切相关,其动态监测对肺心病患者诊治的判断有重要的意义。
Objective To compare the difference of serum BNP at different stages of chronic pulmonary heart disease and left heart failure,and to explore the relationship of BNP to RV,RVOT and LVEF. Methods There were four groups in the study,the control group( group A),the COPD combined with chronic pulmonary heart disease at compensatory stage( group B),the COPD combined with chronic pulmonary heart disease at decompensatory stage( group C),and the left heart failure group( D),100 cases in each group. Their BNP,pulmonary function test and heart doppler ultrasound were tested. The difference of serum BNP levels among the above groups was compared. Correlation analysis was used to identify significant relationships between BNP and variables of interest. Results The serum level of BNP in the group C was much higher than that in the group B( P < 0. 001). And it was higher in the group D than in the group C. In patients with chronic pulmonary heart disease,there was a positive correlation of BNP with RV,RVOT and PASP,a negative correlation with FEV1%,and no correlation with LVEF%.The best cut-off value of BNP on diagnosis in the group B and C was 318. 7 pg / ml,and it was 784. 8 pg / ml in the group C and D. Conclusion The serum level of BNP is related with the clinical stage of chronic pulmonary heart disease. Ambulatory monitoring on serum BNP level is important and significant to make a diagnosis.
Objective To compare the difference of serum BNP at different stages of chronic pulmonary heart disease and left heart failure,and to explore the relationship of BNP to RV,RVOT and LVEF. Methods There were four groups in the study,the control group( group A),the COPD combined with chronic pulmonary heart disease at compensatory stage( group B),the COPD combined with chronic pulmonary heart disease at decompensatory stage( group C),and the left heart failure group( D),100 cases in each group. Their BNP,pulmonary function test and heart doppler ultrasound were tested. The difference of serum BNP levels among the above groups was compared. Correlation analysis was used to identify significant relationships between BNP and variables of interest. Results The serum level of BNP in the group C was much higher than that in the group B( P < 0. 001). And it was higher in the group D than in the group C. In patients with chronic pulmonary heart disease,there was a positive correlation of BNP with RV,RVOT and PASP,a negative correlation with FEV1%,and no correlation with LVEF%.The best cut-off value of BNP on diagnosis in the group B and C was 318. 7 pg / ml,and it was 784. 8 pg / ml in the group C and D. Conclusion The serum level of BNP is related with the clinical stage of chronic pulmonary heart disease. Ambulatory monitoring on serum BNP level is important and significant to make a diagnosis.
引文
[1]Patel JB,Valencik ML,Pritchett AM,et al.Cardiac—specific attenuation of natriuretic peptide A receptor activity accentuates adverse cardiac remodeling and mortality in response to pressure overload.Am J Physiol Heart Circ Physiol[J]2005:289:H777-H784.
[2]农彦林,郭程香,程怀兵,等.BNP对慢阻肺合并慢性左心衰的诊断及药物治疗指导价值.临床肺科杂志[J].2014,19(3):396-398.
[3]胡咏梅,王勉,赵思勤等.B型利钠肽和肺毛细血管嵌压对心力衰竭远期心脏事件的预测价值[J].2008,36(9):786-789.
[4]Baggish AL,Van Kimmenade RR,Januzzi JL,et al.Am ino-terminal pro-B-type natriuretie peptide testing and prognosis in patients with acute dyspnea,including those with acute heart failure.Am J Cardiol[J],2008,101(3A):49-55.
[5]Macdcr MT,Ammann P.Changes in BNP and QTc for prediction of sudden death in heart failure[J].Future Cardiol,2013,9(3):317-320.
[6]PRUSZCZYK,MD,Ph D,FESCN-Terminal.Pro一Brain Natriuretic Peptide as an Indicator of Right Ventricular Dysfunction.Journal of Cardiac Failure[J],2005,11(5):S65-69.
[7]Iltumur K,Karabulut A,Yokus B,et al.N-terminal pro BNP plasma levels correlate with severity of mitral stenosis.The Journal of heart valve disease[J],2005,14(6):735-741.
[8]Masson S,Latini R,Anand IS,et al.Direct comparison of B-type natriuretic peptide(BNP)and amino-terminal pro BNP in a large population of patients with chronic and symptomatic heart failure:the Valsartan Heart Failure(Val-He FT)?.Clinical Chemistry[J],2006,52:1528-l538.
[9]Kriiger S,Graf J,Merx MW,et al.Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism.Am Heart[J],2004,147(1):60-65.
[10]王瑜,欧阳菊艳,姜淑霞,等.肺心病心力衰竭患者心功能与血浆脑钠肽、C-反应蛋白关系分析[J].临床肺科杂志,2014,12:2198-2199,2200.
[11]Nikolaos Flessas,Ioannis Alexanian,John Parissis,et al.Plasma activity of B-type natriuretic peptide in patients with biventricular heart failure versus those with right heart failure due to chronic obstructive pulmonary disease.Journal of cardiovascular medicine(Hagerstown,Md[J].2014,15(6):476-480.
[12]Kucher N,Printzen G,Goldhaber SZ.Prognostic role of brain natriuretic peptide in acute pulmonary embolism.Circulation[J].2003:107:2545-7.
[2]农彦林,郭程香,程怀兵,等.BNP对慢阻肺合并慢性左心衰的诊断及药物治疗指导价值.临床肺科杂志[J].2014,19(3):396-398.
[3]胡咏梅,王勉,赵思勤等.B型利钠肽和肺毛细血管嵌压对心力衰竭远期心脏事件的预测价值[J].2008,36(9):786-789.
[4]Baggish AL,Van Kimmenade RR,Januzzi JL,et al.Am ino-terminal pro-B-type natriuretie peptide testing and prognosis in patients with acute dyspnea,including those with acute heart failure.Am J Cardiol[J],2008,101(3A):49-55.
[5]Macdcr MT,Ammann P.Changes in BNP and QTc for prediction of sudden death in heart failure[J].Future Cardiol,2013,9(3):317-320.
[6]PRUSZCZYK,MD,Ph D,FESCN-Terminal.Pro一Brain Natriuretic Peptide as an Indicator of Right Ventricular Dysfunction.Journal of Cardiac Failure[J],2005,11(5):S65-69.
[7]Iltumur K,Karabulut A,Yokus B,et al.N-terminal pro BNP plasma levels correlate with severity of mitral stenosis.The Journal of heart valve disease[J],2005,14(6):735-741.
[8]Masson S,Latini R,Anand IS,et al.Direct comparison of B-type natriuretic peptide(BNP)and amino-terminal pro BNP in a large population of patients with chronic and symptomatic heart failure:the Valsartan Heart Failure(Val-He FT)?.Clinical Chemistry[J],2006,52:1528-l538.
[9]Kriiger S,Graf J,Merx MW,et al.Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism.Am Heart[J],2004,147(1):60-65.
[10]王瑜,欧阳菊艳,姜淑霞,等.肺心病心力衰竭患者心功能与血浆脑钠肽、C-反应蛋白关系分析[J].临床肺科杂志,2014,12:2198-2199,2200.
[11]Nikolaos Flessas,Ioannis Alexanian,John Parissis,et al.Plasma activity of B-type natriuretic peptide in patients with biventricular heart failure versus those with right heart failure due to chronic obstructive pulmonary disease.Journal of cardiovascular medicine(Hagerstown,Md[J].2014,15(6):476-480.
[12]Kucher N,Printzen G,Goldhaber SZ.Prognostic role of brain natriuretic peptide in acute pulmonary embolism.Circulation[J].2003:107:2545-7.