BNP及hs-CRP血清浓度变化在COPD患者的临床意义

发布时间：2018-04-26 19:39

本文选题：B型钠尿肽 + 超敏C反应蛋白　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)是一种呼吸系统常见疾病。本文通过观察COPD急性加重期及稳定期患者血清中BNP与hs-CRP的水平,以及BNP与hs-CRP数值之间变化的关系,探讨BNP与hs-CRP在临床判断COPD病情严重程度和指导治疗中的意义。方法:选择我院急诊科2015年03月-2016年10月因COPD急性加重住院的患者70例为A组,住院或门诊复诊的24例COPD稳定期患者为B组,我院体检30例健康者为对照组C组,测定三组患者血清BNP及hs-CRP水平,比较各组血清BNP与hs-CRP水平差异;其次分析A组患者的BNP、hs-CRP与慢性阻塞性肺疾病的全球性倡仪(Global Initiative for chronic obstructive pulmonary disease,GOLD)分级的相关性,分析其在反应病情严重程度中的作用;最后比较A组患者治疗前后BNP、hs-CRP及EF值的变化。结果:(1)A组的AECOPD患者治疗前的BNP水平为180.44±75.79pg/ml,hs-CRP水平为38.97±18.21mg/L,两项数据均为三组间最高值(P0.01);B组的稳定期COPD患者BNP、hs-CRP的检测水平分别84.70±14.28pg/ml,17.63±6.23mg/L,而C组健康者血清BNP、hs-CRP浓度为三组间最低,BNP=39.17±10.15pg/ml、hs-CRP=1.30±0.47mg/L;这些差异均有统计学意义(P0.01)(2)Pearson相关性分析可知94例COPD患者血清BNP与hs-CRP呈线性相关,且为正相关(r=0.825,P0.001),回归方程为y(BNP)=39.647+3.471x(CRP)。(3)根据GOLD分级,70例AECOPD患者BNP、hs-CRP水平与GOLD分级水平呈梯度增加,再通过Pearson相关分析可知BNP、hs-CRP水平与AECOPD患者的GOLD评分分级均呈正相关(r=0.581,P0.01和r=0.401,P0.01)。(4)A组经正规治疗后血清BNP、hs-CRP水平变化较治疗前浓度比较均明显下降,且这种差异有显著统计学意义(P0.01),患者治疗前后EF值分别为59.30±10.74%,62.40±10.35%,治疗前后差异无统计学意义(P=0.084)。结论:1.AECOPD患者血浆BNP及hs-CRP水平高于稳定期COPD患者及健康患者,急性期治疗后两指标均下降,这些差异均有统计学意义(P0.01),可在临床指导治疗。2.联合检测BNP及hs-CRP在AECOPD患者临床病情严重程度判断及临床治疗中有一定的指导意义,在没有肺功能仪的情况下可考虑作为一种判断COPD患者病情严重程度及指导治疗方式。
[Abstract]:Objective: chronic obstructive pulmonary disease (copd) is a common respiratory disease. By observing the levels of BNP and hs-CRP in the serum of patients with acute exacerbation and stable stage of COPD, and the relationship between BNP and hs-CRP, the significance of BNP and hs-CRP in judging the severity of COPD and guiding the treatment were discussed. Methods: from March 2015 to October 2016, 70 patients with acute exacerbation of COPD were selected as group A, 24 stable COPD patients in hospital or outpatient department as group B, and 30 healthy persons as control group. The levels of serum BNP and hs-CRP were measured, and the differences of serum BNP and hs-CRP were compared among the three groups. Secondly, the correlation between BNP hs-CRP and global Initiative for chronic obstructive pulmonary disease grade of chronic obstructive pulmonary disease (COPD) was analyzed. Finally, the changes of BNPHs-CRP and EF in group A were compared before and after treatment. Results before treatment, the BNP level of AECOPD patients in group A was 180.44 卤75.79 PG / ml hs-CRP was 38.97 卤18.21 mg / L, the two data were the highest among the three groups, the levels of BNPHs-CRP in stable COPD patients in group B were 84.70 卤14.28 mg / ml 卤6.23 mg / L, respectively, while the lowest levels of BNPhs-CRP in C group were 39.17 卤10.15 mg / L of BNP-hs-CRP-1. 30 卤0.47mgL / L of stable COPD patients, and the lowest levels of BNPHs-CRP in healthy subjects were 39.17 卤10.15pg / ml / L and 1.30 卤0.47mgL / L, respectively84.70 卤14.28pgml / ml 卤6.23 mg / L, respectively. There was a linear correlation between serum BNP and hs-CRP in 94 patients with COPD. The regression equation was y(BNP)=39.647 3.471xhs-CRP and GOLD grading. According to the GOLD grading, the levels of BNPHs-CRP and GOLD grade were increased in 70 patients with AECOPD. The Pearson correlation analysis showed that the level of BNPHs-CRP was positively correlated with the GOLD scores of AECOPD patients, and the changes of serum BNPHs-CRP levels in group A were significantly lower than those before treatment. The EF of the patients before and after treatment was 59.30 卤10.74 and 62.40 卤10.355.There was no significant difference before and after treatment. Conclusion 1. The levels of plasma BNP and hs-CRP in AECOPD patients were higher than those in stable COPD patients and healthy patients, and the two indexes were decreased after acute treatment. The differences were statistically significant (P 0.01) and could be used to guide the treatment. 2. The combined detection of BNP and hs-CRP has certain guiding significance in judging the severity of clinical condition and clinical treatment in AECOPD patients. In the absence of pulmonary function instrument, it can be considered as a way to judge the severity of the disease in patients with COPD and to guide the treatment.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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