慢性阻塞性肺疾病患者N末端脑钠肽原水平与肺功能、血气指标的相关性分析
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摘要
目的分析不同程度慢性阻塞性肺疾病(COPD)患者NT-proBNP水平与其肺功能、血气指标的相关性。方法选取2015年1月—2016年12月四川省凉山州第一人民医院诊治的104例COPD,根据严重程度分为稳定期组和急性加重期组,每组52例。另选取同期52例门诊体检健康者作为健康组。比较3组血清N末端脑钠肽原(NT-pro BNP)水平、第一秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)和血气指标动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)水平,分析NT-pro BNP水平与肺功能及动脉血气分析指标的相关性。结果 COPD稳定期组和急性加重期组血清NT-proBNP水平高于健康组,且急性加重期组高于稳定期组(P<0.05)。COPD稳定期组和急性加重期组FEV1%、FEV1/FVC和PaO_2均低于健康组,PaCO_2高于健康组(P<0.05);COPD急性加重期组FEV1%、FEV1/FVC和Pa O_2水平均低于稳定期组,PaCO_2水平明显高于稳定期组(P<0.05)。COPD患者血清NT-pro BNP水平与FEV1%、FEV1/FVC、PaO_2水平呈负相关(r=-0.694、-0.683、-0.708,P=0.034、0.037、0.031),与PaCO_2水平呈正相关(r=0.769,P=0.025)。结论 COPD患者血清NT-pro BNP水平高于健康组,且可随COPD肺功能和血气指标的改善而降低。
Objective To analyze correlations between NT-pro BNP levels and lung function and blood gas parameters in patients with different degrees of COPD.Methods A total of 104 patients with COPD admitted during January 2015 and December 2016 were divided into stable period group(n=52)and acute exacerbations period group(n=52)according to pathogenetic conditions,and other 52 healthy people taking physical examinations were selected as control group.Serum N-terminal pro-brain natriuretic peptide(NT-pro BNP)level,percentage of forced expiratory volume in one second(FEV1)to prediction value(FEV1%),FEV1/forced vital capacity(FVC)and arterial partial pressure of carbon dioxide(PaO_2)levels were compared,and correlations between NT-pro BNP level with indexes of pulmonary function and arterial blood gas analysis were analyzed in three groups.Results Serum NT-pro BNP levels in stable period and acute exacerbations period groups were significantly higher than that in control group(P<0.05),and the level in acute exacerbations period group was significantly higher than that in stable period group(P<0.05).Values of FEV1%,FEV1/FVC and PaO_2level in stable period and acute exacerbations period groups were significantly lower,while PaCO_2level was significantly higher than those in control group(P<0.05);in acute exacerbations period group,the values were significantly lower,while PaCO_2level was significantly higher than those in stable period group(P<0.05).Serum NT-pro BNP level was negatively correlated with FEV1%,FEV1/FVC and Pa O_2levels(r=-0.694,-0.683 and-0.708,P=0.034,0.037 and 0.031),and it was positively correlated with PaCO_2levels in COPD patients.Conclusion Serum NT-pro BNP levels in COPD patients are significantly higher than those in healthy people,and the level can be decreased with improving lung function and blood gas indexes in patients with COPD.
Objective To analyze correlations between NT-pro BNP levels and lung function and blood gas parameters in patients with different degrees of COPD.Methods A total of 104 patients with COPD admitted during January 2015 and December 2016 were divided into stable period group(n=52)and acute exacerbations period group(n=52)according to pathogenetic conditions,and other 52 healthy people taking physical examinations were selected as control group.Serum N-terminal pro-brain natriuretic peptide(NT-pro BNP)level,percentage of forced expiratory volume in one second(FEV1)to prediction value(FEV1%),FEV1/forced vital capacity(FVC)and arterial partial pressure of carbon dioxide(PaO_2)levels were compared,and correlations between NT-pro BNP level with indexes of pulmonary function and arterial blood gas analysis were analyzed in three groups.Results Serum NT-pro BNP levels in stable period and acute exacerbations period groups were significantly higher than that in control group(P<0.05),and the level in acute exacerbations period group was significantly higher than that in stable period group(P<0.05).Values of FEV1%,FEV1/FVC and PaO_2level in stable period and acute exacerbations period groups were significantly lower,while PaCO_2level was significantly higher than those in control group(P<0.05);in acute exacerbations period group,the values were significantly lower,while PaCO_2level was significantly higher than those in stable period group(P<0.05).Serum NT-pro BNP level was negatively correlated with FEV1%,FEV1/FVC and Pa O_2levels(r=-0.694,-0.683 and-0.708,P=0.034,0.037 and 0.031),and it was positively correlated with PaCO_2levels in COPD patients.Conclusion Serum NT-pro BNP levels in COPD patients are significantly higher than those in healthy people,and the level can be decreased with improving lung function and blood gas indexes in patients with COPD.
引文
[1]赵素娥,杨红忠,朱锦琪,等.长沙市部分社区慢性阻塞性肺疾病的流行病学调查[J].中国医师杂志,2017,19(1):100-102.
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[8]单长波,范建新.慢性阻塞性肺疾病致右心衰竭NTpro BNP水平和Tei指数相关性[J].国际呼吸杂志,2016,36(5):358-360.
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[11]戚永兰,姬文娟.肺弥散功能测定在支气管哮喘和慢性阻塞性肺疾病中的临床应用[J].中国卫生标准管理,2016,7(20):83-84.
[12]杨周溪,丁式行,裘晟.COPD患者血浆NT-pro BNP及Hs-CRP水平检测的临床价值[J].心脑血管病防治,2015,8(2):147-148.
[13]Kuharic J,Sustic A,Marcun R,et al.NT-pro BNP predicts the need for ventilatory support in the patients with acute exacerbation of chronic obstructive pulmonary disease[J].Intensive Care Medicine Experimental,2015,3(Suppl 1):1-2.
[14]王政权,董路兵,李刚,等.NT-pro BNP动态改变在云南地区汉族慢性阻塞性肺疾病合并肺源性心脏病患者诊断及长期预后判断中的意义[J].中国临床医学,2015,14(5):616-620.
[15]杨红亮,孟利敏.25-(OH)D3、NT-pro BNP、PCT对老年慢性阻塞性肺疾病合并心力衰竭患者近期预后的影响[J].中国循证心血管医学杂志,2017,9(4):443-445.
[16]任保艳,朱星成.NT-pro BNP在COPD合并肺心病中的临床应用[J].中华临床医师杂志:电子版,2016,10(11):80-81.
[17]刘会玲.慢性阻塞性肺疾病不同分期患者血清炎性指标、肺功能及血气分析指标的变化[J].临床合理用药杂志,2015,8(24):78-79.
[18]雷怀定,刘玉全,尤辉.两种机械通气对COPD肺动脉高压伴发呼吸衰竭老年患者的疗效及BNP水平的影响[J].贵州医科大学学报,2016,41(11):1343-1346.
[2]Woodruff P G,Agusti A,Roche N,et al.Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy:making progress towards personalised management[J].Lancet,2015,385(9979):1789-1798.
[3]张子洲,陈华芳.降钙素原、急性生理与慢性健康评估Ⅱ评分对慢性阻塞性肺病急性加重期病情危重度的评估价值[J].中国老年学杂志,2016,36(3):648-650.
[4]蔺建平.慢性阻塞性肺疾病患者NT-pro BNP的表达与患者肺功能、血气指标的关系[J].国际呼吸杂志,2016,36(19):1449-1453.
[5]中华人民共和国卫生部.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):484-491.
[6]刘保萍,盛艳玲,唐健滨,等.授权教育干预对慢性阻塞性肺疾病患者管理能力的影响[J].中国医药导报,2016,13(17):113-116,120.
[7]和瑞莲,张国际.慢性阻塞性肺疾病急性加重期抗凝治疗的疗效观察[J].中国煤炭工业医学杂志,2014,17(9):1435-1437.
[8]单长波,范建新.慢性阻塞性肺疾病致右心衰竭NTpro BNP水平和Tei指数相关性[J].国际呼吸杂志,2016,36(5):358-360.
[9]Agostoncoldea L,Petrovai D,Mihalcea I,et al.Right atrium volume index in patients with secondary pulmonary hypertension due to chronic obstructive pulmonary disease[J].Acta Cardiol Sin,2015,31(4):325-336.
[10]张伟,姚玉强,谷明明,等.慢性阻塞性肺疾病对心肌损伤及心肌超微结构的影响[J].广西医学,2014,6(1):5-7.
[11]戚永兰,姬文娟.肺弥散功能测定在支气管哮喘和慢性阻塞性肺疾病中的临床应用[J].中国卫生标准管理,2016,7(20):83-84.
[12]杨周溪,丁式行,裘晟.COPD患者血浆NT-pro BNP及Hs-CRP水平检测的临床价值[J].心脑血管病防治,2015,8(2):147-148.
[13]Kuharic J,Sustic A,Marcun R,et al.NT-pro BNP predicts the need for ventilatory support in the patients with acute exacerbation of chronic obstructive pulmonary disease[J].Intensive Care Medicine Experimental,2015,3(Suppl 1):1-2.
[14]王政权,董路兵,李刚,等.NT-pro BNP动态改变在云南地区汉族慢性阻塞性肺疾病合并肺源性心脏病患者诊断及长期预后判断中的意义[J].中国临床医学,2015,14(5):616-620.
[15]杨红亮,孟利敏.25-(OH)D3、NT-pro BNP、PCT对老年慢性阻塞性肺疾病合并心力衰竭患者近期预后的影响[J].中国循证心血管医学杂志,2017,9(4):443-445.
[16]任保艳,朱星成.NT-pro BNP在COPD合并肺心病中的临床应用[J].中华临床医师杂志:电子版,2016,10(11):80-81.
[17]刘会玲.慢性阻塞性肺疾病不同分期患者血清炎性指标、肺功能及血气分析指标的变化[J].临床合理用药杂志,2015,8(24):78-79.
[18]雷怀定,刘玉全,尤辉.两种机械通气对COPD肺动脉高压伴发呼吸衰竭老年患者的疗效及BNP水平的影响[J].贵州医科大学学报,2016,41(11):1343-1346.