血浆脑钠肽在慢性阻塞性肺病的意义分析概要.doc

血浆脑钠肽在慢性阻塞性肺病的意义分析 摘要 背景：鉴于预后极差，对慢性阻塞性肺病（COPD）患者潜在PH或慢性肺源性心脏病（chronic pulmonary heart disease）其早期确诊极为重要。 目的：在检测COPD病患（于症状及体征上排除肺动脉高压及chronic pulmonary heart disease）其血浆脑钠肽（BNP）层次后，探究血浆BNP于COPD预后预测里起到什么功能。 方法：检测60位COPD患者、10位哮喘患者、30位健康人员的血浆BNP水平，同时检测超声心动图、动脉血气分析、肺功能。随访3年，对比COPD病患中高血浆BNP层次和低层次其死亡率和恶化状况。 结果：COPD组的血浆BNP水平（41±6.6pg/ml）显著比健康组（14.8±2.7pg/ml）（p＜0.0001）和哮喘组（17.4±4.5pg/ml）（p＜0.05）的高。血浆BNP层次和肺功能或血氧层次没有显著联系，但和左室射血分数（r= -0.41,p=0.0197）及肺动脉收缩压（r= 0.5,p=0.004）有显著关联。在COPD组测得血浆BNP程度高者出现急性加剧期显然减少了（p＜0.05）。chronic pulmonary heart disease急性加剧时间其血浆BNP层次（79.9±16.2pg/ml）比稳定期（41.2±8.7pg/ml）显著升高（p=0.004）。 结论：血浆BNP水平作为一项无创的生物标志物可用以筛查潜在的肺动脉高压及左心室功能障碍，也可用于稳定期慢性阻塞性肺病发生急性加重的预测。 关键词：慢性阻塞性肺病，脑钠肽，肺动脉高压，慢性肺源性心脏病。 Abstract Background : Early diagnosis of chronic obstructive pulmonary disease (COPD) with latent pulmonary hypertension (PH) and cor pulmonale is important because the prognosis of this condition is poor. Objective:To investigate the utility of brain natriuretic peptide (BNP) for prognostication of COPD, plasma BNP was measured in patients with COPD without symptoms or physical findings of PH or cor pulmonale. Methods:Plasma BNP was measured in 60 patients with COPD, 10 asthmatics, and 30 healthy subjects. Echocardiography, arterial blood gas analysis, and spirometry were also performed. Mortality and exacerbation were compared between COPD patients with high and low plasma BNP levels over a 3-year follow-up period. Results : Plasma BNP (mean ± SEM, pg/mL) in COPD patients (41.0±6.6) was significantly higher than in normal subjects (14.8±2.7) and asthmatics (17.4±4.5) (p0.0001 and p0.05, respectively). No significant correlations were observed between plasma BNP level and pulmonary function or hypoxia. There was, how-ever, a significant correlation between plasma BNP level and % ejection fraction (r=-0.41, p=0.0197) and pulmonary artery systolic pressure (r=0.5, p=0.004). The period until initial COPD exacerbation in subjects with a high plasma BNP level was significantly s