Budweiser Stephan, Luchner Andreas, Jörres Rudolf A, Heinemann Frank, Hitzl André P, Schmidbauer Kathrin, Riegger Günter, Pfeifer Michael
Center for Pneumology, Hospital Donaustauf, Ludwigstrasse 68, D-93093 Donaustauf, Germany.
Respir Med. 2007 Sep;101(9):2003-10. doi: 10.1016/j.rmed.2007.04.001. Epub 2007 May 25.
Natriuretic peptides are considered as reliable indicators of left-heart failure (HF) and are useful for differential diagnosis of dyspnoea.
We evaluated the clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with chronic hypercapnic respiratory failure (CHRF).
In 60 patients with CHRF, plasma concentrations of NT-proBNP were assessed at baseline and after treatment including non-invasive ventilation (NIV). The relationship of NT-proBNP to disease severity and its predictive value for survival were evaluated up to 4 years.
NT-proBNP levels were markedly elevated in patients with CHRF (n=60; geometric mean (SD) 546.4 (4.9) pg/mL; p<0.001) compared to healthy controls (n=182; 49.0 (2.2) pg/mL). After excluding patients with concomitant HF or renal impairment, levels were still increased (n=43; 393.2 (3.8) pg/mL; p<0.001). According to multivariate regression, hypoxia and exacerbation independently determined NT-proBNP levels (p<0.05 each). After initiation of NIV, blood gases and lung function improved and NT-proBNP decreased (-31.3 (0.3)%; p<0.001). During 22.5 (2.2) months follow-up, NT-proBNP was not significantly associated with survival in the total population, however, the subgroup of patients with levels >722 pg/mL (67th percentile) and no adherence to NIV displayed poor prognosis (hazard ratio=0.21; 95%-CI=0.022-0.580; p=0.0091).
NT-proBNP was highly elevated in patients with CHRF and correlated with the degree of respiratory impairment and exacerbation. Correspondingly, treatment including NIV led to reduction of NT-proBNP. These data indicate a potential role of NT-proBNP in assessing disease severity, treatment efficacy and prognosis in CHRF.
利钠肽被认为是左心衰竭（HF）的可靠指标，有助于呼吸困难的鉴别诊断。
我们评估了N末端脑钠肽前体（NT-proBNP）在慢性高碳酸血症呼吸衰竭（CHRF）患者中的临床意义。
在60例CHRF患者中，在基线时以及包括无创通气（NIV）在内的治疗后评估NT-proBNP的血浆浓度。评估NT-proBNP与疾病严重程度的关系及其对长达4年生存的预测价值。
与健康对照者（n = 182；49.0（2.2）pg/mL）相比，CHRF患者（n = 60；几何均数（标准差）546.4（4.9）pg/mL；p<0.001）的NT-proBNP水平显著升高。排除合并HF或肾功能损害的患者后，水平仍然升高（n = 43；393.2（3.8）pg/mL；p<0.001）。根据多因素回归分析，低氧和病情加重独立决定NT-proBNP水平（各p<0.05）。开始NIV治疗后，血气和肺功能改善，NT-proBNP降低（-31.3（0.3）%；p<0.001）。在22.5（2.2）个月的随访期间，NT-proBNP在总体人群中与生存无显著相关性，然而，NT-proBNP水平>722 pg/mL（第67百分位数）且未坚持NIV治疗的患者亚组预后较差（风险比=0.21；95%置信区间=0.022-0.580；p = 0.0091）。
CHRF患者的NT-proBNP水平显著升高，与呼吸功能损害程度和病情加重相关。相应地，包括NIV在内的治疗导致NT-proBNP降低。这些数据表明NT-proBNP在评估CHRF疾病严重程度、治疗疗效和预后方面具有潜在作用。
