Application of B-type brain natriuretic peptide in patients with acute exacerbation of chronic obstructive pulmonary disease with left ventricular ejection fraction retention
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摘要:目的
分析左心室射血分数（LVEF）保留的慢性阻塞性肺疾病急性加重期（AECOPD）患者血清B型脑钠肽（BNP）与动脉血氧分压[pa（O2）]、超敏C反应蛋白（hs-CRP）、右心室舒张末期横径（RVDD）及预后死亡的相关性。
方法回顾性分析150例LVEF保留的AECOPD患者病例资料，根据血清BNP水平分为A组（BNP≤100 pg/mL，n=82）、B组（BNP>100~400 pg/mL，n=45）、C组（BNP>400 pg/mL，n=23）。比较入院后3组患者pa（O2）、BNP、hs-CRP及RVDD水平。分析BNP与pa（O2）、hs-CRP、RVDD的相关性；采用Logistic回归分析探讨1年内死亡预测因素。统计3组患者1年内的死亡危险比（RR）。
结果B组、C组pa（O2）低于A组，BNP、hs-CRP、RVDD高于A组，差异有统计学意义（P < 0.05）；C组BNP、hs-CRP高于B组，差异有统计学意义（P < 0.05）。相关性分析显示，BNP与pa（O2）呈负相关（r=-0.385，P < 0.001），与hs-CRP、RVDD呈正相关（r=0.664、0.388，P < 0.001）；1年内，C组与A组、B组的RR及95%CI分别为1.303（1.019~1.668）、1.263（0.978~1.630），差异有统计学意义（P < 0.05）。BNP是患者1年内死亡的独立预测因素（P < 0.05）。
结论LVEF保留的AECOPD患者血清BNP水平升高与pa（O2）降低、hs-CRP升高及RVDD增大有关。血清BNP是评估AECOPD病情及预后死亡的敏感指标。
Abstract:ObjectiveTo analyze the correlations of serum B-type brain natriuretic peptide (BNP) with arterial partial pressure of oxygen[pa(O2)], high-sensitivity C-reactive protein (hs-CRP), right ventricular end diastolic diameter (RVDD) and death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and left ventricular ejection function (LVEF) preservation.
MethodsThe data of 150 AECOPD patients with LVEF preservation were retrospectively analyzed. According to the serum BNP level, they were divided into group A (BNP ≤ 100 pg/mL, n=82), group B (BNP>100 pg/mL to 400 pg/mL, n=45) and group C (BNP>400 pg/mL, n=23). The pa(O2), BNP, hs-CRP and RVDD were compared among the three groups after admission. The correlations of BNP with pa(O2), hs-CRP as well as RVDD were analyzed; predictors of death within 1 year were analyzed by Logistic regression. The 1 year mortality risk ratio (RR) of the 3 groups was analyzed.
ResultsThe pa(O2) in group B and group C was significantly lower than that in group A, and BNP, hs-CRP and RVDD were higher than those in group A (P < 0.05). BNP and hs-CRP in group C were significantly higher than those in group B (P < 0.05). Correlation analysis showed that BNP was negatively correlated with pa(O2) (r=-0.385, P < 0.001), but positively correlated with hs-CRP and RVDD (r=0.664, 0.388, P < 0.001). Within 1 year, the RR and 95%CI of group C with group A and group B were 1.303(1.019 to 1.668) and 1.263(0.978 to 1.630), respectively, and the differences were statistically significant (P < 0.05). BNP was an independent predicting factor for death within 1 year (P < 0.05).
ConclusionThe elevated BNP level in AECOPD patients with LVEF preservation is associated with decreased pa(O2) level, increased hs-CRP, and increased RVDD. Serum BNP is a sensitive indicator for assessing the condition of AECOPD and death.
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表 1 3组患者一般资料比较(x±s)[n(%)]
组别 年龄/岁 性别 BMI/(kg/m2) 吸烟史 血肌酐
清除率/(mL/min)肺功能 男 女 FEV1/L FEV1%/% (FEV1/FVC)/% A组(n=82) 68.87±6.89 57(69.51) 25(30.48) 21.29±1.81 67(81.71) 74.52±18.98 0.76±0.28 36.76±13.36 41.83±9.54 B组(n=45) 70.96±5.69 30(66.67) 15(33.33) 21.62±2.11 33(73.33) 78.16±20.49 0.72±0.20 36.91±10.12 42.47±11.43 C组(n=23) 67.52±9.42 15(65.22) 8(34.78) 21.17±1.96 18(78.26) 76.35±18.50 0.68±0.14 34.50±6.07 42.61±7.91 BMI: 体质量指数; FEV1: 第1秒用力呼气容积; FEV1%: 第1秒用力呼气容积占预计值百分比;
FEV1/FVC: 第1秒用力呼气容积与用力肺活量比值。
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表 2 3组患者临床资料比较(x±s)[n(%)]
组别 使用支气管扩张剂 上一年度急性加重
次数≥2次心功能分级 合并症 Ⅰ级 Ⅱ级 Ⅲ级 支气管扩张 陈旧性肺结核 肺心病 A组(n=82) 59(71.95) 52(63.41) 37(45.12) 25(30.49) 20(24.39) 9(10.98) 8(9.76) 4(4.88) B组(n=45) 28(62.22) 40(88.89) 11(24.44) 14(31.11) 20(44.44) 13(28.89) 9(20.00) 4(8.89) C组(n=23) 14(60.87) 21(91.30) 4(17.39) 8(34.78) 11(47.83) 8(34.78) 5(21.74) 3(13.04) F/χ2 1.766 13.876 10.993 9.537 3.522 1.991 P 0.413 < 0.001 0.027 0.008 0.172 0.369
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表 3 3组患者pa(O2)、BNP、hs-CRP及RVDD水平比较(x±s)
组别 pa(O2)/mmHg BNP/(pg/mL) hs-CRP/(mg/L) RVDD/mm A组(n=82) 74.03±14.25 43.50±11.87 12.52±3.83 23.22±3.80 B组(n=45) 61.02±13.22* 242.89±52.85* 33.95±10.23* 27.80±4.77* C组(n=23) 55.21±11.27* 664.47±143.61*# 64.04±15.67*# 30.09±8.66* pa(O2): 动脉血氧分压; BNP: 血清B型脑钠肽; hs-CRP: 超敏C反应蛋白; RVDD: 右心室舒张末期横径。
与A组比较, *P < 0.05; 与B组比较, #P < 0.05。
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表 4 LVEF保留的AECOPD患者1年内死亡预测因素的Logistic回归性分析
指标 β SE Wald χ2 P OR 95%CI pa(O2) 0.009 0.027 0.118 0.731 1.009 0.958~1.064 BNP -0.005 0.002 5.740 0.017 1.005 1.001~1.008 hs-CRP 0.010 0.024 0.190 0.663 0.990 0.944~1.037 RVDD 0.008 0.059 0.020 0.887 1.008 0.899~1.131 心功能 -0.357 0.613 0.339 0.561 0.700 0.210~2.326 上一年度急性加重次数≥2次 0.570 1.180 0.234 0.629 1.769 0.175~17.860 合并支气管扩张 0.610 0.758 0.648 0.421 1.840 0.417~8.128 常量 2.340 2.560 0.836 0.361 10.382 — pa(O2): 动脉血氧分压; BNP: 血清B型脑钠肽; hs-CRP: 超敏C反应蛋白; RVDD: 右心室舒张末期横径。
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[1] YU S S, ZHANG J, FANG Q H, et al. Blood eosinophil levels and prognosis of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Am J Med Sci, 2021, 362(1): 56-62. doi: 10.1016/j.amjms.2021.02.013
[2] MAISE A, MUELLER C, PEACOCK W F, et al. 2008中西方BNP专家共识[J]. 中国医药导刊, 2009, 11(10): 1628-1637. doi: 10.3969/j.issn.1009-0959.2009.10.003 [3] ABROUG F, OUANES-BESBES L, NCIRI N, et al. Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disease: diagnostic performance of cardiac biomarkers[J]. Am J Respir Crit Care Med, 2006, 174(9): 990-996. doi: 10.1164/rccm.200603-380OC
[4] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会, 陈荣昌, 等. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205. doi: 10.3760/cma.j.cn112147-20210109-00031 [5] YAO C, WANG L W, SHI F, et al. Optimized combination of circulating biomarkers as predictors of prognosis in AECOPD patients complicated with Heart Failure[J]. Int J Med Sci, 2021, 18(7): 1592-1599. doi: 10.7150/ijms.52405
[6] 吕骁, 张宏英, 毛雅云, 等. BNP、HCAR及D-D在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭中的变化及与病情、预后的相关性[J]. 临床误诊误治, 2021, 34(6): 86-91. doi: 10.3969/j.issn.1002-3429.2021.06.018 [7] 王宝俊, 王华, 张金莲. 慢性阻塞性肺疾病急性加重期患者血浆中肌钙蛋白Ⅰ、脑钠肽及血尿酸测定的临床意义[J]. 国际呼吸杂志, 2016, 36(16): 1225-1227. doi: 10.3760/cma.j.issn.1673-436X.2016.16.006 [8] NISHIMURA K, NISHIMURA T, ONISHI K, et al. Changes in plasma levels of B-type natriuretic peptide with acute exacerbations of chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2014, 9: 155-162.
[9] HAWKINS N M, KHOSLA A, VIRANI S A, et al. B-type natriuretic peptides in chronic obstructive pulmonary disease: a systematic review[J]. BMC Pulm Med, 2017, 17(1): 11. doi: 10.1186/s12890-016-0345-7
[10] 王煜. 慢性阻塞性肺疾病中脑钠肽水平的变化及其临床意义[J]. 陕西医学杂志, 2013, 42(1): 18-20. doi: 10.3969/j.issn.1000-7377.2013.01.005 [11] 胡旭, 靳开宇, 范贤明. 慢性阻塞性肺疾病合并支气管扩张的发病机制、诊断与治疗研究进展[J]. 山东医药, 2016, 56(31): 106-108. doi: 10.3969/j.issn.1002-266X.2016.31.036 [12] 廉静, 张爱菊, 张燕. 超敏C反应蛋白与扩张型心肌病患者炎症因子水平、心功能的相关性[J]. 心血管康复医学杂志, 2018, 27(6): 642-645. doi: 10.3969/j.issn.1008-0074.2018.06.07 [13] 吴长东, 侯铭, 杨嵘, 等. 联合检测二维超声心动图、BNP、6MWT、MMRC对慢性阻塞性肺疾病急性加重期患者右心功能不全的诊断意义[J]. 中华肺部疾病杂志: 电子版, 2019, 12(4): 441-444. doi: 10.3877/cma.j.issn.1674-6902.2019.04.008 [14] 王潇, 许爱国. 频繁急性加重的慢性阻塞性肺疾病继发肺动脉高压的危险因素分析[J]. 河南医学研究, 2020, 29(31): 5782-5785. doi: 10.3969/j.issn.1004-437X.2020.31.006 [15] MAO B, LU H W, LI M H, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD[J]. Sci Rep, 2015, 5: 10961. doi: 10.1038/srep10961
[16] PARK S Y, LEE C Y, KIM C, et al. One-year prognosis and the role of brain natriuretic peptide levels in patients with chronic cor pulmonale[J]. J Korean Med Sci, 2015, 30(4): 442-449. doi: 10.3346/jkms.2015.30.4.442
[17] 赵娜, 谢才德. 血浆B型脑钠肽水平在慢性阻塞性肺疾病近远期治疗预后评估中的价值[J]. 临床肺科杂志, 2017, 22(3): 427-430. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFK201703011.htm [18] 谢小兵, 高云, 牛灵, 等. 急性加重期和稳定期COPD患者血清CRP、IL-6、PCT及BNP水平变化[J]. 山东医药, 2020, 60(30): 73-75. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202030019.htm -
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