慢性阻塞性肺疾病合并心力衰竭患者血清超敏C反应蛋白、脑自然肽氨基端前体蛋白及肾小球滤过率变化及意义

Changes and significances of serum high-sensitivity C reactive protein, N-terminal pro-brain natiuretic peptide and glomerular filtration rate in patients with chronic obstructive pulmonary disease complicated with heart failure

  • 摘要: 目的 探讨慢性阻塞性肺疾病(COPD)合并心力衰竭患者血清超敏C反应蛋白(hs-CRP)、脑自然肽氨基端前体蛋白(NT-proBNP)及肾小球滤过率(GFR)的变化及意义。 方法 回顾性分析94例COPD患者的临床资料,按照是否合并心力衰竭将患者分为COPD合并心力衰竭组(n=69)与单纯COPD组(n=25)。另选取同期进行体检的100例健康人为正常对照组。观察COPD合并心力衰竭患者血清hs-CRP、NT-proBNP和GFR的变化。 结果 COPD合并心力衰竭组的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平显著高于单纯COPD组和正常对照组(P<0.05), 高密度脂蛋白胆固醇(HDL-C)水平显著低于单纯COPD组和正常对照组(P<0.05)。COPD合并心力衰竭组的白细胞介素-1β(IL-1β)、hs-CRP、肿瘤坏死因子-α(TNF-α)、NT-proBNP、血肌酐(Scr)水平显著高于单纯COPD组和正常对照组(P<0.05), GFR水平显著低于单纯COPD组和正常对照组(P<0.05)。Logistic回归分析显示, hs-CRP(OR=1.826, P=0.037)、NT-proBNP(OR=1.848, P=0.021)、GFR(OR=1.779, P=0.024)是COPD合并心力衰竭的影响因素。按照美国纽约心脏病协会(NYHA)的分级方案将COPD合并心力衰竭组患者心功能分为Ⅰ~Ⅳ级,血清hs-CRP、NT-proBNP水平由高到低依次为Ⅳ级、Ⅲ级、Ⅱ级、Ⅰ级, GFR水平由低到高依次为Ⅳ级、Ⅲ级、Ⅱ级、Ⅰ级,差异均有统计学意义(P<0.05)。 结论 分析COPD合并心力衰竭患者血清hs-CRP、NT-proBNP和GFR水平的变化可有效反映患者心功能状况及心力衰竭严重程度。

     

    Abstract: Objective To explore changes and significance of serum high sensitivity C reactive protein(hs-CRP), N-terminal pro-brain natiuretic peptide(NT-proBNP)and glomerular filtration rate(GFR)in patients with chronic obstructive pulmonary disease(COPD)complicated with heart failure. Methods A retrospective analysis was performed on clinical records of 94 COPD patients. According to presence or absence of heart failure, they were divided into COPD combined with heart failure group(n=69)and simple COPD group(n=25). In the same period, 100 healthy people underwent physical examination were enrolled as normal control group. The changes in serum hs-CRP, NT-proBNP and GFR in patients with COPD and heart failure were observed. Results The levels of total cholesterol(TC), triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)in COPD combined with heart failure group were significantly higher than those in simple COPD group and - normal control group(P<0.05), while level of high-density lipoprotein cholesterol(HDL-C)was significantly lower than that in simple COPD group and normal control group(P<0.05). The levels of interleukin-1β(IL-1β), hs-CRP, tumor necrosis factor-α(TNF-α), NT-proBNP and serum creatinine(Scr)in COPD combined with heart failure group were significantly higher than those in simple COPD group and normal control group(P<0.05), while GFR level was significantly lower than that in simple COPD group and normal control group(P<0.05). Logistic regression analysis showed hs-CRP(OR=1.826, P=0.037), NT-proBNP(OR=1.848, P=0.021)and GFR(OR=1.779, P=0.024)were influencing factors for COPD combined with heart failure(P<0.05). According to grading scheme of New York Heart Association(NYHA), cardiac function of COPD combined with heart failure group was divided into grade Ⅰ to Ⅳ. The levels of serum hs-CRP and NT proBNP in COPD had an increase trend in Ⅳ, Ⅲ, Ⅱ and Ⅰ, and the level of GFR had an decrease trend in Ⅳ, Ⅲ, Ⅱ and Ⅰ(P<0.05). Conclusion Analysis in changes of serum hs-CRP, NT-proBNP and GFR levels in patients with COPD combined with heart failure can effectively reflect cardiac function status and its severity.

     

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