血浆脑钠肽在慢性阻塞性肺病预后预测的价值

发布时间：2018-01-07 18:05

本文关键词：血浆脑钠肽在慢性阻塞性肺病预后预测的价值　出处：《南昌大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:慢性阻塞性肺病(COPD)是一种持续气流受限为特征的慢性支气管炎或肺气肿,气流受限呈进行性发展,不完全可逆,可进一步发展成为呼吸系统衰竭或肺心病,其发病与外源性有害物质及气道异常的炎症反应相关,致残率、病死率较高,对患者的身心均造成长期伤害。COPD初期急性发作过后,临床表现虽好转,但肺功能并无明显改善,仍在持续慢性恶化,造成肺动脉高压,逐渐发展为肺心病(PH)。脑钠肽是有心脏分泌的,能够促进排尿、排钠,舒张血管、调节血压。众多研究发现血浆脑钠肽与超敏C反应蛋白(Hs-CRP)及动脉氧分压(Pa O2)相关,本研究通过对COPD患者的血浆脑钠肽水平进行检测,为临床中COPD患者的治疗及预防提供切实的依据,为其预后提供良好的临床指导。目的:通过检测慢性阻塞性肺病患者(在症状和体征上排除肺动脉高压及慢性肺源性心脏病)的血浆脑钠肽(BNP)水平,探讨BNP在COPD预后预测中的作用。方法:检测60位COPD患者、10位哮喘患者、30位健康人员的血浆BNP水平,同时检测超声心动图、动脉血气分析、肺功能。随访3年,对比COPD患者中高血浆BNP水平和低水平的死亡率和恶化程度。结果:COPD组的血浆BNP水平(41±6.6pg/ml)显著比健康组(14.8±2.7pg/ml)(p0.0001)和哮喘组(17.4±4.5pg/ml)(p0.05)的高。在COPD组测得血浆BNP水平高者发生急性加重的时间明显缩短(p0.05)。慢性阻塞性肺病急性加重期的血浆BNP水平(79.9±16.2pg/ml)比稳定期(41.2±8.7pg/ml)显著升高(p=0.004)。结论:在稳定期COPD患者的血浆BNP水平会升高,高血BNP水平是急性加重的独立危险因素,但与死亡率无关。可以用于筛查潜在肺动脉高压、左心室功能紊乱,可以用于预测COPD患者急性加重的概率。
[Abstract]:Background: chronic obstructive pulmonary disease (COPD) is a kind of persistent airflow limitation is characteristic of chronic bronchitis or emphysema, airflowlimitation is progressive, irreversible, can be further developed into respiratory failure or pulmonary heart disease, inflammatory reaction and the occurrence of exogenous harmful substances and abnormal airway morbidity, mortality the rate is high, the patient's physical and mental injuries are caused by long-term.COPD early after the onset of acute clinical manifestations, although improved, but there was no obvious improvement in lung function, continued chronic deterioration caused by pulmonary hypertension, developed pulmonary heart disease (PH). Brain natriuretic peptide is secreted from the heart, can promote urination, discharge sodium, blood vessels, regulating blood pressure. Many studies found that plasma brain natriuretic peptide and high sensitive C reactive protein (Hs-CRP) and arterial oxygen partial pressure (Pa O2), this study examined through plasma brain natriuretic peptide level in patients with COPD, pro To provide the basis for treatment and prevention of COPD patients in bed, to provide clinical guidance for good prognosis. Objective: through the detection of patients with chronic obstructive pulmonary disease (exclude pulmonary hypertension and chronic pulmonary heart disease in symptom and sign) of the plasma brain natriuretic peptide (BNP) level, to explore the role of BNP in COPD prognosis prediction. Methods: 60 patients with COPD, 10 patients with asthma, the plasma BNP levels of 30 healthy people at the same time, detection of echocardiography, arterial blood gas analysis, pulmonary function. 3 years of follow-up, mortality high plasma BNP levels and the low level of contrast in patients with COPD and the degree of deterioration. Results: the level of plasma BNP in group COPD (41 + 6.6pg/ml) was significantly lower than healthy group (14.8 + 2.7pg/ml) (P0.0001) and asthma group (17.4 + 4.5pg/ml) (P0.05) high. In the COPD group measured the level of plasma BNP high occurrence of acute exacerbation time was shorter (P0.05) in patients with chronic obstructive pulmonary disease. Acute exacerbation period of the plasma level of BNP (79.9 + 16.2pg/ml) than stable phase (41.2 + 8.7pg/ml) increased significantly (p=0.004). Conclusion: the level of plasma BNP in COPD patients in the stable period will rise, high blood levels of BNP are independent risk factors of acute exacerbation, but not with mortality. Can be used for screening potential pulmonary hypertension left ventricular dysfunction, and can be used to predict the probability of acute exacerbation of COPD patients.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.9

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