NT-proBNP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

摘要

目的：探讨N末端B型脑钠肽前体（N‐terminal pro‐B‐type natriuretic peptide ，NT‐proBNP）水平及其动态改变在云南地区汉族慢性阻塞性肺疾病（chronic obstructive pulmonary disease ，COPD）合并肺源性心脏病患者诊断及长期预后判断中的意义。方法：选择2013年1月—12月云南省曲靖市第二人民医院收治的COPD患者234例，其中COPD合并肺源性心脏病98例，COPD急性发作80例，COPD稳定期56例，入院后记录患者的基本临床资料、血气分析及心脏超声结果，并测定 N T‐proBNP水平。结果：COPD急性发作组和COPD合并肺源性心脏病组6 min步行试验距离低于COPD稳定期组（P＜0．01）；COPD合并肺源性心脏病组NT‐proBNP水平高于COPD稳定期组和COPD急性发作组（P＜0．01）。Kaplan‐Meier生存分析提示，COPD合并肺源性心脏病组中入院时NT‐proBNP水平＜1000 pg／mL组和≥1000 pg／mL组在12个月时再次入院和死亡等终点事件发生率差异无统计学意义（P＞0．05），治疗后NT‐proBNP水平降低率≥30％组在12个月时再次入院和死亡等终点事件发生率低于＜30％组（P＜0．05）。结论：NT‐proBNP测定对早期诊断COPD合并肺源性心脏病具有重要的价值，治疗前后NT‐proBNP水平的动态变化较单次的NT‐proBNP水平检测可以更好地预测COPD合并肺源性心脏病患者的再住院和死亡风险。%Objective:To explore the clinical significance of the level and dynamic changes of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in the diagnosis and prediction of long‐term prognosis for patients with chronic obstructive pulmonary disease (COPD) combined with pulmonary heart disease among Han Chinese in Yunnan district .Methods:A total of 234 patients with COPD who were treated in The Second People′s Hospital of Qujing in Yunnan province during Jan .2013 and Dec .2013 ,were selected .Among them ,there were 98 patients with COPD combined with pulmonary heart disease ,80 patients with acute exacerbation of COPD ,and 56 patients with stable COPD .The clinical data ,results of blood gas analysis and echocardiography were recorded on admission and the levels of NT‐proBNP were measured .Results:The distances of 6 minute walk test(6MWT) in acute exacerbation of COPD and COPD combined with pulmonary heart disease groups were significantly less than that in stable COPD group(P< 0 .01) .The level of NT‐proBNP in COPD combined with pulmonary heart disease group was significantly higher than those in stable COPD and acute exacerbation of COPD group(P< 0 .01) .Kaplan‐Meier survival analysis showed that there was no significant difference regarding the rate of readmission and death during 12 months between the NT‐proBNP<1 000 pg/mL group and the NT‐proBNP≥1 000 pg/mL group(P>0 .05) .The rate of readmission and death during 12 months in the group with NT‐proBNP level decreasing ratio after treatment ≥30% was significantly higher than that in the group with decreasing ratio < 30% (P< 0 .05) .Conclusions: The detection of NT‐proBNP is of great significance to the early diagnosis of COPD combined with pulmonary heart disease .The dynamic changes of NT‐proBNP levels before and after the treatment are superior to single detection of NT‐proBNP level in predicting readmission rate and mortality risk for patients with COPD combined with pulmonary heart disease .