BNP联合三维超声心动图评价慢性肺心病患者的应用价值
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摘要
目的探讨BNP联合实时三维超声心动图评价慢性肺源性心脏病(简称肺心病)患者的应用价值。方法选择我院2016年9月至2018年3月在本院接受诊断与治疗的患者,其中肺心病代偿组、肺心病失代偿组(呼吸困难组、右心衰组和全心衰组),每组各50例。另外,选择同期在我院进行健康体检的健康人50例作为对照。采用电化学发光双抗体夹心法检测血清脑钠肽(BNP)水平,彩色超声诊断仪监测肺动脉压(PASP)、右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室射血分数(RVEF)、右室每搏量(RVSV)。BNP和三维超声心动图指标的相关性检验采用Pearson分析。结果健康对照组血清BNP为(143.50±22.51)ng/L,肺心病代偿组为(311.87±45.11)ng/L,呼吸困难组为(758.64±63.14)ng/L,右心衰组为(2134.25±214.01)ng/L,全心衰组为(6237.36±325.48)ng/L。随着病情进展,血清BNP水平组间升高,差异有统计学意义(F_(1,245)=121.425,P<0.001)。随着病情加重,PASP、RVEDV和RVESV逐渐升高(F_(1,245)=15.121,P<0.001;F_(1,245)=9.121,P<0.001;F_(1,245)=9.121,P<0.001),RVSV和RVEF(F_(1,245)=12.254,P<0.001;F_(1,245)=10.201,P=0.003)逐渐下降,差异有统计学意义。相关性分析发现,BNP与PASP、、RVEDV、RVESV、RVSV、RVEF均有明显的相关性(r=0.458、0.684、0.354、-0.715、-0.654,P<0.05)。结论血清BNP和三维超声心动图指标具有明显的相关性,二者联合检测有利于肺心病患者的诊断和预后评价,未来需要进一步的长期随访观察以明确其价值。
Objective To investigate the value of brain natriuretic peptide(BNP) combined with three-dimensional echocardiography in patients with chronic pulmonary heart disease. Methods The patients who received diagnosis and treatment in our hospital from September 2016 to March 2018 were selected, including the pulmonary heart disease compensatory group and the pulmonary heart disease decompensation group(the dyspnea group, the right heart failure group and the heart failure group), 50 patients in each group. In addition, 50 healthy persons in our hospital during the same period were selected as the controls. The level of BNP was detected by electrochemiluminescence double antibody sandwich method, and PASP, RVEDV, RVESV, RVEF and RVSV were monitored by color ultrasonic diagnostic apparatus. The correlation between BNP and three dimensional echocardiography was analyzed by Pearson analysis. Results The serum BNP was(143.50±22.51) ng/L in the healthy control group,(311.87±45.11) ng/L in the cor pulmonale compensatory group,(758.64±63.14) ng/L in the dyspnea group,(2134.25±214.01) ng/L in the right heart failure group, and(6237.36±325.48) ng/L in the whole heart failure group. With the progression of the disease, the serum BNP level increased, and the difference was statistically significant(F_(1,245)=121.425, P<0.001). With the aggravation of the disease, PASP, RVEDV and RVESV were gradually increased(F_(1,245)=15.121, P<0.001; F_(1,245)=9.121, P<0.001; F_(1,245)=9.121, P<0.001). RVSV and RVEF(F_(1,245)=12.254, P<0.001; F_(1,245)=10.201, P=0.003) decreased gradually. The correlation analysis showed that BNP had significant correlation with PASP, RVEDV, RVESV, RVSV and RVEF(r=0.458, 0.684, 0.354,-0.715,-0.654, P<0.05). Conclusion There is a significant correlation between serum BNP and three dimensional echocardiography. The combined detection of the two is beneficial to the diagnosis and prognosis evaluation of chronic pulmonary heart disease, and further long-term follow-up is needed to clarify its value in future.
Objective To investigate the value of brain natriuretic peptide(BNP) combined with three-dimensional echocardiography in patients with chronic pulmonary heart disease. Methods The patients who received diagnosis and treatment in our hospital from September 2016 to March 2018 were selected, including the pulmonary heart disease compensatory group and the pulmonary heart disease decompensation group(the dyspnea group, the right heart failure group and the heart failure group), 50 patients in each group. In addition, 50 healthy persons in our hospital during the same period were selected as the controls. The level of BNP was detected by electrochemiluminescence double antibody sandwich method, and PASP, RVEDV, RVESV, RVEF and RVSV were monitored by color ultrasonic diagnostic apparatus. The correlation between BNP and three dimensional echocardiography was analyzed by Pearson analysis. Results The serum BNP was(143.50±22.51) ng/L in the healthy control group,(311.87±45.11) ng/L in the cor pulmonale compensatory group,(758.64±63.14) ng/L in the dyspnea group,(2134.25±214.01) ng/L in the right heart failure group, and(6237.36±325.48) ng/L in the whole heart failure group. With the progression of the disease, the serum BNP level increased, and the difference was statistically significant(F_(1,245)=121.425, P<0.001). With the aggravation of the disease, PASP, RVEDV and RVESV were gradually increased(F_(1,245)=15.121, P<0.001; F_(1,245)=9.121, P<0.001; F_(1,245)=9.121, P<0.001). RVSV and RVEF(F_(1,245)=12.254, P<0.001; F_(1,245)=10.201, P=0.003) decreased gradually. The correlation analysis showed that BNP had significant correlation with PASP, RVEDV, RVESV, RVSV and RVEF(r=0.458, 0.684, 0.354,-0.715,-0.654, P<0.05). Conclusion There is a significant correlation between serum BNP and three dimensional echocardiography. The combined detection of the two is beneficial to the diagnosis and prognosis evaluation of chronic pulmonary heart disease, and further long-term follow-up is needed to clarify its value in future.
引文
[1] 郑家群.慢性阻塞性肺疾病氧疗进展[J].临床肺科杂志,2016,21(12):2294-2296.
[2] GRIGNOLA J C,TRUJILLO P,DOMINGO E.Pulmonary vascular disease due to left heart disease:how to achieve a more accurate approach beyond the haemodynamic phenotype[J].Eur J Heart Fail,2018,20(5):942-943.
[3] ELSAYED M,BULUR S,KALLA A,et al.Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of aortic atherosclerotic thrombi and ulcers[J].Echocardiography,2016,33(8):1234-1238.
[4] KIM J,COHEN S B,ATALAY M K,et al.Quantitative assessment of right ventricular volumes and ejection fraction in patients with left ventricular systolic dysfunction by real time three-dimensional echocardiography versus cardiac magnetic resonance imaging[J].Echocardiography,2015,32(5):805-812.
[5] WANG Y,GU X,FAN W,et al.Effects of recombinant human brain natriuretic peptide on renal function in patients with acute heart failure following myocardial infarction[J].Am J Transl Res,2016,8(1): 239-245.
[6] 赵妍,孙耕耘.脑钠肽和N-末端脑钠肽前体在慢性肺源性心脏病中的应用价值[J/OL].中华肺部疾病杂志(电子版),2017,10(6):740-742[2018-08-17].http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zhonghfbjbzz201706027& dbid=WF_QK.DOI:10.3877/cma.j.issn.1674-6902.2017.06.027.
[7] MCKIE P M,SCHIRGER J A,BENIKE S L,et al.Chronic subcutaneous brain natriuretic peptide therapy in asymptomatic systolic heart failure[J].Eur J Heart Fail,2016,18(4):433-441.
[8] AMSALLEM M,STERNBACH J M,ADIGOPULA S,et al.Addressing the controversy of estimating pulmonary arterial pressure by echocardiography[J].J Am Soc Echocardiogr,2016,29(2):93-102.
[9] 刘怡,陈明,郑建华,等.实时三维超声右心室容积曲线评价肺心病右心室收缩功能的价值[J].中国医学影像学杂志,2008,16(2):91-93.
[10] 魏智民,蔡建芳,崔华,等.北京地区4960例慢性阻塞性肺病住院患者心血管疾病发生率的回顾性调查[J].中华流行病学杂志,2011,32(3):297-301.
[11] EINDHOVEN J A,VAN DEN BOSCH A E,BOERSMA E,et al.The usefulness of brain natriuretic peptide in simple congenital heart disease - a systematic review[J].Cardiol Young,2013,23(3):315-324.
[12] FIJALKOWSKA A,KURZYNA M,TORBICKI A,et al.Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension[J].Chest,2006,129(5):1313-1321.
[13] JELIC S,LE JEMTEL T H.Diagnostic usefulness of B-type natriuretic peptide and functional consequences of muscle alterations in COPD and chronic heart failure[J].Chest,2006,130(4):1220-1230.
[14] 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):246-248.
[15] 田甜,赵蓉,杨倩玫,等.超声心动图对不同病程的慢性肺源性心脏病患者右心功能改变的评估[J].中国超声医学杂志,2018,34(3):121-125.
[16] ROY-LACROIX M E,MORETTI F,FERRARO Z M,et al.A comparison of standard two-dimensional ultrasound to three-dimensional volume sonography for routine second-trimester fetal imaging[J].J Perinatol,2017,37(4):228-231.
[17] SHIUE I,PERKINS D R,BEARMAN N.Pulmonary heart disease but not pulmonary embolism admissions peaked at physiologically equivalent temperature 0℃ in Germany in 2009-2011[J].Int J Cardiol,2014,177(2):584-585.
[18] NOVAES J Y,ZAMITH M M,ARAUJO ,et al.Screening of congenital heart diseases by three-dimensional ultrasound using spatiotemporal image correlation:influence of professional experience[J].Echocardiography,2016,33(1):99-104.
[19] LU H,CHEN S,WANG H,et al.Role of adrenomedullin in congenital heart disease associated with pulmonary hypertension[J].J Huazhong Univ Sci Technolog Med Sci,2003,23(3):275-277.
[20] MANTUANI D,NAGDEV A.Three-view bedside ultrasound to differentiate acute decompensated heart failure from chronic obstructive pulmonary disease[J].Am J Emerg Med,2013,31(4):759.e3-759.e5.
[2] GRIGNOLA J C,TRUJILLO P,DOMINGO E.Pulmonary vascular disease due to left heart disease:how to achieve a more accurate approach beyond the haemodynamic phenotype[J].Eur J Heart Fail,2018,20(5):942-943.
[3] ELSAYED M,BULUR S,KALLA A,et al.Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of aortic atherosclerotic thrombi and ulcers[J].Echocardiography,2016,33(8):1234-1238.
[4] KIM J,COHEN S B,ATALAY M K,et al.Quantitative assessment of right ventricular volumes and ejection fraction in patients with left ventricular systolic dysfunction by real time three-dimensional echocardiography versus cardiac magnetic resonance imaging[J].Echocardiography,2015,32(5):805-812.
[5] WANG Y,GU X,FAN W,et al.Effects of recombinant human brain natriuretic peptide on renal function in patients with acute heart failure following myocardial infarction[J].Am J Transl Res,2016,8(1): 239-245.
[6] 赵妍,孙耕耘.脑钠肽和N-末端脑钠肽前体在慢性肺源性心脏病中的应用价值[J/OL].中华肺部疾病杂志(电子版),2017,10(6):740-742[2018-08-17].http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zhonghfbjbzz201706027& dbid=WF_QK.DOI:10.3877/cma.j.issn.1674-6902.2017.06.027.
[7] MCKIE P M,SCHIRGER J A,BENIKE S L,et al.Chronic subcutaneous brain natriuretic peptide therapy in asymptomatic systolic heart failure[J].Eur J Heart Fail,2016,18(4):433-441.
[8] AMSALLEM M,STERNBACH J M,ADIGOPULA S,et al.Addressing the controversy of estimating pulmonary arterial pressure by echocardiography[J].J Am Soc Echocardiogr,2016,29(2):93-102.
[9] 刘怡,陈明,郑建华,等.实时三维超声右心室容积曲线评价肺心病右心室收缩功能的价值[J].中国医学影像学杂志,2008,16(2):91-93.
[10] 魏智民,蔡建芳,崔华,等.北京地区4960例慢性阻塞性肺病住院患者心血管疾病发生率的回顾性调查[J].中华流行病学杂志,2011,32(3):297-301.
[11] EINDHOVEN J A,VAN DEN BOSCH A E,BOERSMA E,et al.The usefulness of brain natriuretic peptide in simple congenital heart disease - a systematic review[J].Cardiol Young,2013,23(3):315-324.
[12] FIJALKOWSKA A,KURZYNA M,TORBICKI A,et al.Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension[J].Chest,2006,129(5):1313-1321.
[13] JELIC S,LE JEMTEL T H.Diagnostic usefulness of B-type natriuretic peptide and functional consequences of muscle alterations in COPD and chronic heart failure[J].Chest,2006,130(4):1220-1230.
[14] 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):246-248.
[15] 田甜,赵蓉,杨倩玫,等.超声心动图对不同病程的慢性肺源性心脏病患者右心功能改变的评估[J].中国超声医学杂志,2018,34(3):121-125.
[16] ROY-LACROIX M E,MORETTI F,FERRARO Z M,et al.A comparison of standard two-dimensional ultrasound to three-dimensional volume sonography for routine second-trimester fetal imaging[J].J Perinatol,2017,37(4):228-231.
[17] SHIUE I,PERKINS D R,BEARMAN N.Pulmonary heart disease but not pulmonary embolism admissions peaked at physiologically equivalent temperature 0℃ in Germany in 2009-2011[J].Int J Cardiol,2014,177(2):584-585.
[18] NOVAES J Y,ZAMITH M M,ARAUJO ,et al.Screening of congenital heart diseases by three-dimensional ultrasound using spatiotemporal image correlation:influence of professional experience[J].Echocardiography,2016,33(1):99-104.
[19] LU H,CHEN S,WANG H,et al.Role of adrenomedullin in congenital heart disease associated with pulmonary hypertension[J].J Huazhong Univ Sci Technolog Med Sci,2003,23(3):275-277.
[20] MANTUANI D,NAGDEV A.Three-view bedside ultrasound to differentiate acute decompensated heart failure from chronic obstructive pulmonary disease[J].Am J Emerg Med,2013,31(4):759.e3-759.e5.