Department of Internal Medicine, Chonnam National University Hospital, 671 Jaebongro, Dongku, Kwangju 501-757, Korea.
Lung. 2012 Jun;190(3):271-6. doi: 10.1007/s00408-011-9363-7. Epub 2012 Jan 14.
Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are elevated in patients with secondary pulmonary hypertension and chronic lung disease with right ventricular overload. The aim of the present study was to investigate the use of plasma NT-proBNP levels as a prognostic marker of severe COPD with chronic respiratory failure and latent pulmonary hypertension.
Plasma NT-proBNP levels were measured in 61 patients with stable COPD. Plasma NT-proBNP levels, pulmonary function, PaO(2), and PaCO(2) levels and systolic pulmonary artery pressure were compared according to COPD severity. In addition, we examined correlations between plasma NT-proBNP levels and pulmonary function, PaO(2), PaCO(2), and systolic pulmonary artery pressure.
The levels of plasma NT-proBNP significantly increased in patients with stage IV and stage III COPD compared to individuals with stage II COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The area under the receiver-operating characteristic curve of plasma NT-proBNP for severe to very severe COPD (FEV(1) <50%) was 0.707 (95% confidence interval [CI] 0.566-0.847, P=0.008). Plasma NT-proBNP levels significantly correlated with %FEV(1) (r= -0.557; P < 0.001), arterial blood gas parameters such as PaCO(2) (r = 0.476; P < 0.001) and PaO(2) (r = -0.347; P = 0.031), and systolic pulmonary artery pressure (r = 0.435; P = 0.001).
Plasma NT-proBNP levels increased significantly with disease severity, progression of chronic respiratory failure, and secondary pulmonary hypertension in patients with stable COPD. These results suggest that plasma NT-proBNP can be a useful prognostic marker to monitor COPD progression and identify cases of secondary pulmonary hypertension in patients with stable COPD.
在患有继发性肺动脉高压和右心室超负荷的慢性肺病患者中，血浆 N 末端脑利钠肽前体（NT-proBNP）水平升高。本研究的目的是探讨血浆 NT-proBNP 水平作为慢性阻塞性肺疾病（COPD）合并慢性呼吸衰竭和潜在肺动脉高压患者的预后标志物的应用价值。
对 61 例稳定期 COPD 患者进行血浆 NT-proBNP 水平检测。根据 COPD 严重程度比较血浆 NT-proBNP 水平、肺功能、PaO（2）、PaCO（2）水平和收缩期肺动脉压。此外，我们还检查了血浆 NT-proBNP 水平与肺功能、PaO（2）、PaCO（2）和收缩期肺动脉压之间的相关性。
根据全球慢性阻塞性肺疾病倡议（GOLD）分类，与 II 期 COPD 患者相比，IV 期和 III 期 COPD 患者的血浆 NT-proBNP 水平显著升高。血浆 NT-proBNP 对严重至非常严重 COPD（FEV（1）<50%）的受试者工作特征曲线下面积为 0.707（95%置信区间 [CI] 0.566-0.847，P=0.008）。血浆 NT-proBNP 水平与 %FEV（1）显著相关（r=-0.557；P<0.001），与动脉血气参数如 PaCO（2）（r=0.476；P<0.001）和 PaO（2）（r=-0.347；P=0.031）以及收缩期肺动脉压（r=0.435；P=0.001）显著相关。
在稳定期 COPD 患者中，随着疾病严重程度的增加、慢性呼吸衰竭的进展和继发性肺动脉高压，血浆 NT-proBNP 水平显著升高。这些结果表明，血浆 NT-proBNP 可作为监测 COPD 进展和识别稳定期 COPD 患者继发性肺动脉高压的有用预后标志物。
