血浆脑钠肽测定在慢性阻塞性肺疾病合并急性呼吸困难病因鉴别的临床意义

摘要

目的：探讨血浆脑钠肽( BNP)在鉴别慢性阻塞性肺疾病( COPD)合并急性呼吸困难病因鉴别的临床应用价值。方法：78例COPD合并急性呼吸困难患者分为3组,A组43例为单纯COPD患者,B组15例为COPD合并左心功能不全患者,C组20例为COPD合并右心功能不全患者。比较3组血浆 BNP水平和超声心动图检查结果,采用受试者工作特征曲线确定BNP的诊断临界值。结果：3组血浆BNP水平分别为A组(60.3±55.8)pg/ml、B组(1489.4±1011.3)pg/ml、C组(437.9±391.3)pg/ml,3组差异均有统计学意义(P<0.01)。超声心动图检查结果显示,A组和C组患者左心室内径均明显小于B组；A组患者左心室射血分数均明显高于B组和C组(P<0.01),而C组左心室射血分数亦显著高于B组(P<0.01)；C组患者右心室内径和肺动脉压力均明显高于A组和B组(P<0.01)；B组患者右心室/左心室内径比均显著小于A组和C组(P<0.01)。以受试者工作特征曲线确定血BNP临界值为100 pg/ml,预测心功能不全敏感性为83.5%,特异度81.5%。结论：测定血浆BNP对于COPD患者合并急性呼吸困难时病因鉴别诊断有重要价值,血浆BNP值增高程度与心功能不全的类型有关。%Objective:To study the clinical value of brain natriuretic peptide(BNP) assay in the diagnosis of chronic obstructive pulmonary disease(COPD) complicating with acute dyspnea. Methods:Seventy-eight COPD patients presenting with acute dyspnea were divided into 3 groups:group A contained 43 patients without heart insufficiency,group B 15 patients complicating with left heart insufficiency and group C 20 patients complicating with right heart insufficiency. The plasma BNP levels and ultrasonic cardiogram were measured and compared among the 3 groups;and the BNP cut-off value was determined by the subject performance curve. Results:The BNP level was(60.3±55.8)pg/ml in group A,(1 489.4±1 011.3)pg/ml in group B and(437.9±391.3)pg/ml in group C;the difference was significant among the 3 groups(P <0. 01). Echocardiography data showed that the left ventricular inner diameter in group A and group C was significantly less than that in group B;the left ventricular ejection fraction in group A was significantly higher than that in group B and group C(P<0. 01),and the left ventricular ejection fraction in group C was significantly higher than that in group B(P<0. 01);The internal dimension of the right ventricular and the pulmonary artery pressure in group C were higher than those in group B and group A(P<0. 01);The internal dimension of the right ventricle/left ventricle in group B was significantly less than that in group A and group C(P<0. 01). The BNP cut-off value was defined as 100 pg/ml by subjects performance curve;the sensitivity of cardiac insufficiency was predicted as 83. 5%,and the specificity as 81. 5%. Conclusions:The measurement of the plasma BNP level is essential to differential diagnosis of dyspnea etiology in patients with COPD;and the BNP levels are correlated with the type of the heart insufficiency.