徐育良

【摘要】 目的：研究N端脑钠肽前体（NT-ProBNP）与呼吸衰竭及慢性肺源性心脏病的相关性。方法：筛选和收集2012年1月-2013年12月本科收治的符合单纯呼吸衰竭（A组50例）和呼吸衰竭合并慢性肺心病（B组50例）诊断标准的患者。并选取在本院进行健康体检者（C组）的血样50份，进行血液NT-proBNP水平检测。比较三组的血液NT-proBNP水平，并对A、B两组治疗前后的NT-proBNP水平、血气指标进行比较。记录患者6个月内不良事件发生情况。结果：A、B两组治疗前、后的NT-proBNP水平均显著高于C组，差异均有统计学意义（P<0.05）；B组在治疗前NT-proBNP水平显著高于A组，差异有统计学意义（P<0.05）；A、B两组在治疗后的NT-proBNP水平比较无统计学意义（P>0.05）。经过6～12个月随访，在100例呼吸衰竭患者中，因住院期间发生的病情加重需机械通气、心肺复苏或任何原因的死亡等不良事件共23次，因病情加重需再次住院有37次。发生相关不良事件的患者的NT-proBNP水平为（2849.7±394.7）pg/L显著高于未发生不良事件者的（988.7±93.1）pg/L，差异有统计学意义（P<0.05）。结论：NT-proBNP水平与呼吸衰竭患者是否有肺心病及右心受累程度密切相关，是快速判断右心功能不全严重程度以及疗效判断的良好指标。

【关键词】 慢性肺心病； 呼吸衰竭； N端脑钠肽前体

【Abstract】 Objective：To study the correlation of NT-proBNP with respiratory failure and chronic pulmonary heart disease.Method：100 patients who diagnosed with pure respiratory failure （the group A， 50 cases） and respiratory failure with chronic pulmonary heart disease （the group B， 50 cases） were selected in our hospital from January 2012 to December 2013， and healthy persons （the group C， 50 cases） were detected the levels of blood NT-proBNP were selected at the same time. NT-proBNP blood levels of the three groups， and NT-proBNP levels， blood gas analysis before and after treatment were compared between the group A and B. Adverse events were recorded within 6 months.Result：Before and after treatment， the NT-proBNP levels of the group A， B were significantly higher the group C （P<0.05）. The NT-proBNP levels of the group B were significantly higher than the group A before treatment （P<0.05）， but there were no significant difference between the two groups about NT-proBNP levels after treatment （P>0.05）. After 6 to 12 months of follow-up， 100 cases of respiratory failure in patients， the disease occurred during hospitalization due to exacerbation requiring mechanical ventilation， cardiopulmonary resuscitation， or death from any cause other adverse events were 23 times exacerbations requiring hospitalization had 37 times again. The NT-proBNP levels of occurred related adverse events was （2849.7±394.7） pg/L，and was significantly higher than the patients with no adverse events of （988.7±93.1） pg/L （P<0.05）.Conclusion：NT-proBNP levels in patients with respiratory failure， pulmonary heart disease and whether the degree of right ventricular involvement is closely related， is quick to judge a good indicator of the severity of right ventricular dysfunction and the effect of the judgment.

【Key words】 Chronic pulmonary heart disease； Respiratory failure； NT-proBNPendprint

First-authors address：Shiqi Suhuazan Hospital of Zhongshan City，Zhongshan 528400，China

doi：10.3969/j.issn.1674-4985.2014.18.024

呼吸衰竭是一系列生理功能和代谢紊乱的临床综合征，主要由于各种原因引起肺通气和/或换气功能严重障碍，动脉血氧分压因此降低，导致缺氧伴（或不伴）CO2潴留[1]。N端脑钠肽前体（NT-ProBNP）是由心室合成和分泌的一种神经激素，其合成和分泌会随着心室容量和压力负荷的增加而增加。NT-proBNP检测在21世纪初开始引进我国，由于NT-proBNP在血浆中比较稳定，检测方便，近年来已被各级医院和各级医师广泛用于心力衰竭、冠心病、急性肺损伤、肺动脉高压等多种疾病的诊断及预后的评估[2-6]。但NT-proBNP与呼吸衰竭及慢性肺心病的相关性仍有争议[7]。本课题通过检测呼吸衰竭、慢性肺心病患者血液中NT-proBNP水平，观察其相关性，并探讨NT-proBNP水平与疾病治疗指导和预后关系，旨在对呼吸衰竭、慢性肺心病病情预后评估提供依据。……