Values of N-terminal B-type natriuretic peptide and cardiac troponin I in evaluating disease condition of patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension
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摘要: 目的 探讨血浆N末端B型钠尿肽原(NT-proBNP)及心肌肌钙蛋白I(cTnI)评估慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者病情的价值。 方法 选取COPD合并PH患者79例作为合并组, 87例未发生PH的COPD患者为非合并组, 40名健康体检者为对照组。比较各组患者入院后48 h内氧合指数、6 min步行距离(6MWT)、血乳酸、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)、机械通气率、平均住院时间、NT-proBNP、cTnI等指标。 结果 合并组与非合并组患者的氧合指数、6MWT、血乳酸、APACHEⅡ评分、机械通气率、平均住院时间等指标比较,差异均有统计学意义(P<0.05)。合并组患者NT-proBNP、cTnI、右室舒张末期内径结果均显著高于非合并组与对照组(P<0.05); 非合并组NT-proBNP、cTnI指标水平显著高于对照组(P<0.05)。多因素Logistic回归分析结果显示, NT-proBNP、cTnI、氧合指数、血乳酸是COPD患者行机械通气的影响因素(P<0.05)。NT-proBNP联合cTnI诊断COPD合并PH的灵敏度、特异度均较高。 结论 NT-proBNP与cTnI不仅在诊断COPD合并PH中具有重要意义,而且能够对COPD合并PH患者的病情严重程度及预后进行预测,可以作为评估COPD是否合并PH及右心功能不全的敏感的血清生物学标志物。Abstract: Objective To explore the values of N-terminal B-type natriuretic peptide(NT-proBNP)and cardiac troponin I(cTnI)in evaluating disease condition of patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH). Methods Totally 79 COPD patients with PH were selected as combined group, 87 COPD patients without PH were selected as non-combined group, and 40 healthy people were selected as control group. The indexes such as oxygenation index, 6-minute walking distance(6MWT), blood lactate, acute physiology and chronic health score Ⅱ(APACHE Ⅱ), rate of mechanical ventilation, average hospital stay, NT-proBNP level and cTnI level were compared between groups. Results There were significant differences in oxygenation index, 6MWT, blood lactate, APACHE Ⅱ score, mechanical ventilation rate and average hospital stay between combined group and non-combined group(P<0.05). The results of NT-proBNP, cTnI and the end diastolic diameter of right ventricle in the combined group were significantly higher than those in the non-combined group and the control group(P<0.05), and the levels of NT-proBNP and cTnI in the non-combined group were significantly higher than those in the control group(P<0.05). Multivariate Logistic regression analysis showed that NT-proBNP, cTnI, oxygenation - index and blood lactate were the influencing factors of mechanical ventilation in COPD patients(P<0.05). The sensitivity and specificity of NT-proBNP combined with cTnI were relatively higher in the diagnosis of COPD patients with PH. Conclusion NT-proBNP and cTnI are not only important in the diagnosis of COPD patients with PH, but also can predict the severity of disease and prognosis of patients, and they can be used as sensitive serum biomarkers in evaluation COPD patients with or without PH and right heart dysfunction.
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