血浆脑钠肽测定在慢性阻塞性肺疾病合并急性呼吸困难病因鉴别的临床意义

王骥

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血浆脑钠肽测定在慢性阻塞性肺疾病合并急性呼吸困难病因鉴别的临床意义

王骥

文章导航 > 蚌埠医学院学报 > 2014, 39 > 8: (1034-1036)

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血浆脑钠肽测定在慢性阻塞性肺疾病合并急性呼吸困难病因鉴别的临床意义

王骥

安徽省马鞍山市十七冶医院内科, 243000

作者简介: 王骥（1978-），男，主治医师.

中图分类号: R563.9

Clinical significance of brain natriuretic peptide assay in the diagnosis of chronic obstructive pulmonary disease presenting with acute dyspnea

WANG Ji

Department of Cardiovasology, Shiqiye Hospital, Maanshan Anhui 243000, China
CLC number: R563.9

摘要: 目的：探讨血浆脑钠肽（BNP）在鉴别慢性阻塞性肺疾病（COPD）合并急性呼吸困难病因鉴别的临床应用价值。方法：78例COPD合并急性呼吸困难患者分为3组，A组43例为单纯COPD患者，B组15例为COPD合并左心功能不全患者，C组20例为COPD合并右心功能不全患者。比较3组血浆BNP水平和超声心动图检查结果，采用受试者工作特征曲线确定BNP的诊断临界值。结果：3组血浆BNP水平分别为A组（60.3±55.8）pg/ml、B组（1 489.4±1 011.3）pg/ml、C组（437.9±391.3）pg/ml，3组差异均有统计学意义（P<0.01）。超声心动图检查结果显示，A组和C组患者左心室内径均明显小于B组；A组患者左心室射血分数均明显高于B组和C组（P<0.01），而C组左心室射血分数亦显著高于B组（P<0.01）；C组患者右心室内径和肺动脉压力均明显高于A组和B组（P<0.01）；B组患者右心室/左心室内径比均显著小于A组和C组（P<0.01）。以受试者工作特征曲线确定血BNP临界值为100 pg/ml，预测心功能不全敏感性为83.5%，特异度81.5%。结论：测定血浆BNP对于COPD患者合并急性呼吸困难时病因鉴别诊断有重要价值，血浆BNP值增高程度与心功能不全的类型有关。
- 肺疾病, 阻塞性 /
- 呼吸困难 /
- 脑钠肽
Abstract: Objective: To study the clinical value of brain natriuretic peptide(BNP) assay in the diagnosis of chronic obstructive pulmonary disease(COPD) complicating with acute dyspnea.Methods: Seventy-eight COPD patients presenting with acute dyspnea were divided into 3 groups:group A contained 43 patients without heart insufficiency,group B 15 patients complicating with left heart insufficiency and group C 20 patients complicating with right heart insufficiency.The plasma BNP levels and ultrasonic cardiogram were measured and compared among the 3 groups;and the BNP cut-off value was determined by the subject performance curve.Results: The BNP level was(60.3±55.8)pg/ml in group A,(1 489.4±1 011.3)pg/ml in group B and(437.9±391.3)pg/ml in group C;the difference was significant among the 3 groups(P<0.01).Echocardiography data showed that the left ventricular inner diameter in group A and group C was significantly less than that in group B;the left ventricular ejection fraction in group A was significantly higher than that in group B and group C(P<0.01),and the left ventricular ejection fraction in group C was significantly higher than that in group B(P<0.01);The internal dimension of the right ventricular and the pulmonary artery pressure in group C were higher than those in group B and group A(P<0.01);The internal dimension of the right ventricle/left ventricle in group B was significantly less than that in group A and group C(P<0.01).The BNP cut-off value was defined as 100 pg/ml by subjects performance curve;the sensitivity of cardiac insufficiency was predicted as 83.5%,and the specificity as 81.5%.Conclusions: The measurement of the plasma BNP level is essential to differential diagnosis of dyspnea etiology in patients with COPD;and the BNP levels are correlated with the type of the heart insufficiency.
- pulmonary /
- disease, obstructive /
- dyspnea

[1]	宋爱新.慢性心力衰竭患者血浆脑钠肽水平变化及其意义[J].临床医学, 2012, 32(9):66-67.
[2]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志, 2007, 30(1):8-18.
[3]	石成虎, 胡风涛.B型脑钠肽的临床应用[J].中国医药指南, 2012, 10(12):470-471.
[4]	王春彬.B型脑钠肽与不同病因心力衰竭的研究进展[J].心血管病学进展, 2008, 29(3):458-461.
[5]	仇爱民, 陶章, 张海林.脑钠肽对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的意义[J].临床肺科杂志, 2012, 17(4):631-632.
[6]	Leuchte HH, Holzapfel M, Baumgartner RA, et al.Clinical significance of brain natriuretic peptide in primary pulmonary hypertension[J].J Am Coll Cardiol, 2004, 43(5):764-770.
[7]	王永兰.西宁地区血浆脑钠肽对慢性阻塞性肺病合并慢性充血性心力衰竭患者的诊断意义[J].青海医药杂志, 2009, 39(11):1-2.
[8]	Morrison LK, Harrison A, Krishnaswamy P, et al.Utility of a rapid B-natfiuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea[J].J Am Coil Cardiol, 2002, 39(2):202-209.
[9]	王占胜, 胡健, 宋占春, 等.脑钠肽近4年研究热点文献计量学分析[J].医学综述, 2012, 18(9):1421-1424.

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血浆脑钠肽测定在慢性阻塞性肺疾病合并急性呼吸困难病因鉴别的临床意义

王骥

作者简介: 王骥（1978-），男，主治医师.

安徽省马鞍山市十七冶医院内科, 243000

收稿日期: 2013-08-15

关键词:

摘要: 目的：探讨血浆脑钠肽（BNP）在鉴别慢性阻塞性肺疾病（COPD）合并急性呼吸困难病因鉴别的临床应用价值。方法：78例COPD合并急性呼吸困难患者分为3组，A组43例为单纯COPD患者，B组15例为COPD合并左心功能不全患者，C组20例为COPD合并右心功能不全患者。比较3组血浆BNP水平和超声心动图检查结果，采用受试者工作特征曲线确定BNP的诊断临界值。结果：3组血浆BNP水平分别为A组（60.3±55.8）pg/ml、B组（1 489.4±1 011.3）pg/ml、C组（437.9±391.3）pg/ml，3组差异均有统计学意义（P<0.01）。超声心动图检查结果显示，A组和C组患者左心室内径均明显小于B组；A组患者左心室射血分数均明显高于B组和C组（P<0.01），而C组左心室射血分数亦显著高于B组（P<0.01）；C组患者右心室内径和肺动脉压力均明显高于A组和B组（P<0.01）；B组患者右心室/左心室内径比均显著小于A组和C组（P<0.01）。以受试者工作特征曲线确定血BNP临界值为100 pg/ml，预测心功能不全敏感性为83.5%，特异度81.5%。结论：测定血浆BNP对于COPD患者合并急性呼吸困难时病因鉴别诊断有重要价值，血浆BNP值增高程度与心功能不全的类型有关。

English Abstract

Clinical significance of brain natriuretic peptide assay in the diagnosis of chronic obstructive pulmonary disease presenting with acute dyspnea

WANG Ji

Department of Cardiovasology, Shiqiye Hospital, Maanshan Anhui 243000, China

Received Date: 2013-08-15

Abstract: Objective: To study the clinical value of brain natriuretic peptide(BNP) assay in the diagnosis of chronic obstructive pulmonary disease(COPD) complicating with acute dyspnea.Methods: Seventy-eight COPD patients presenting with acute dyspnea were divided into 3 groups:group A contained 43 patients without heart insufficiency,group B 15 patients complicating with left heart insufficiency and group C 20 patients complicating with right heart insufficiency.The plasma BNP levels and ultrasonic cardiogram were measured and compared among the 3 groups;and the BNP cut-off value was determined by the subject performance curve.Results: The BNP level was(60.3±55.8)pg/ml in group A,(1 489.4±1 011.3)pg/ml in group B and(437.9±391.3)pg/ml in group C;the difference was significant among the 3 groups(P<0.01).Echocardiography data showed that the left ventricular inner diameter in group A and group C was significantly less than that in group B;the left ventricular ejection fraction in group A was significantly higher than that in group B and group C(P<0.01),and the left ventricular ejection fraction in group C was significantly higher than that in group B(P<0.01);The internal dimension of the right ventricular and the pulmonary artery pressure in group C were higher than those in group B and group A(P<0.01);The internal dimension of the right ventricle/left ventricle in group B was significantly less than that in group A and group C(P<0.01).The BNP cut-off value was defined as 100 pg/ml by subjects performance curve;the sensitivity of cardiac insufficiency was predicted as 83.5%,and the specificity as 81.5%.Conclusions: The measurement of the plasma BNP level is essential to differential diagnosis of dyspnea etiology in patients with COPD;and the BNP levels are correlated with the type of the heart insufficiency.