广州医科大学学报

目的:探讨慢性肺源性心脏病失代偿期患者血浆N-端脑利钠肽前体(NT-proBNP)的变化及其临床意义。方法:将2012年1月至2015年1月广东省江门市新会区第二人民医院收治的69例慢性肺源性心脏病失代偿期患者与52例慢性阻塞性肺疾病(COPD)患者作为研究对象,采用快速电化学发光法分别测定两组患者血浆NT-proBNP浓度,并行血气分析和心脏彩色超声检查。待治疗缓解后复查血浆NTproBNP浓度。结果:慢性肺源性心脏病失代偿期患者急性加重期NT-proBNP浓度显著高于COPD急性加重期患者(P<0.05),各组急性加重期NT-proBNP浓度显著高于缓解期(P<0.05)。慢性肺源性心脏病失代偿期患者急性加重期血浆NT-proBNP水平与肺动脉压、右心室舒张期内径、右心室流出道宽度、总血红蛋白呈正相关(P<0.05);COPD患者急性加重期NT-proBNP水平与PAP呈正相关(P<0.05)。结论:血浆NT-proBNP参与了肺源性心脏病的病理生理过程,测定NT-proBNP浓度有助于判断肺源性心脏病病情严重程度。

Objective: To investigate the level of N-terminal pro-brain natriuretic peptide( NT-proBNP) and its clinical significance in patients with decompensated chronic cor pulmonale. Methods: Included in this study were 69 patients with decompensated chronic cor pulmonale( CCP) and 52 patients with chronic obstructive pulmonary disease( COPD) treated for acute exacerbation of their condition at Xinhui District Second People's Hospital of Jiangmen between January 2012 and January 2015. Rapid electrochemiluminescence assay was used to measure the plasma level of NT-proBNP in the patients. The patients also underwent blood gas analysis and color Doppler cardiac ultrasonography. When remission was achieved,the patients received a follow-up measurement of plasma NT-proBNP. Results: During acute exacerbation,patients with decompensated CCP had significantly higher level of NT-proBNP than those with COPD( P < 0. 05). In either group of patients,the NTproBNP level was significantly higher during acute exacerbation than during remission( P < 0. 05). During an acute exacerbation of decompensated CCP,the plasma NT-proBNP level was positively correlated with the pulmonary artery pressure,diameter of right ventricle during diastolic phase,width of right ventricular outflow tract,and total hemoglobin( P < 0. 05). Conclusion: The plasma NT-proBNP may be involved in pathophysiology of cor pulmonale. Measurement of NT-proBNP level may help determine the severity of cor pulmonale.