Wang Yina, Yang Yu, Chen Ping, Luo Yingquan, Yang Yue
Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 Apr;37(4):325-31. doi: 10.3969/j.issn.1672-7347.2012.04.001.
To investigate the effect of nasal intermittent positive pressure ventilation (NIPPV) on N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure.
Forty patients with AECOPD and type II respiratory failure and 40 patients with stable phase chronic obstructive pulmonary disease were randomly assigned into study. Plasma levels of NT-proBNP, arterial blood gas, APACHE II scores, and pulmonary artery pressures were measured. The plasma level of NT-proBNP was compared between the two groups. Effect of NIPPV on NT-proBNP was studied in patients with AECOPD and type II respiratory failure.
There were negative correlations between NT-proBNP and pH, and between NT-proBNP and PaO2 (r=-0.691,r=-0.704,respectively;P<0.001),positive correlations between NT-proBNP and PaCO2, and between NT-proBNP and APACHE II scores (r=0.774, r=0.810, respectively, P< 0.001), and positive correlation between NT-proBNP and PAP (r=0.965, P<0.001) in all patients. In patients with AECOPD and type II respiratory failure, there were negative correlations between NT-proBNP and pH,and between NT-proBNP and PaO2 (r=-0.636, r=-0.616,respectively; P<0.001); there were positive correlations between NT-proBNP and PaCO2, and between NTproBNP and APACHE II scores (r=0.545, r=0.475, respectively; P=0.001, P=0.002); and there were positive correlation between NT-proBNP and pulmonary artery pressure (r=0.833,P<0.001). The plasma levels of NT-proBNP were significantly higher in patients with AECOPD and type II respiratory failure than in control subjects [(939.60 ± 250.00) pg/mL vs (151.55 ± 111.20) pg/mL;P<0.01]. NIPPV decreased plasma levels of NT-proBNP [(229.15 ± 98.26) pg/mL vs (939.60 ± 250.00) pg/mL; P<0.01] in patients with AECOPD and type II respiratory failure, as well as improved arterial blood gas and APACHE II scores. Although NIPPV appeared to decrease pulmonary artery pressure somewhat between pre-treatment and post-treatment groups, the differences were not statistically significant (P=0.056).
The plasma level of NT-proBNP reflects the severity of patients with AECOPD and type II respiratory failure. NIPPV can decrease a patient's splasma level of NT-proBNP, which has clinical value for evaluating the effect of NIPPV.
探讨经鼻间歇正压通气（NIPPV）对慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者N末端脑钠肽前体（NT-proBNP）的影响。
将40例AECOPD合并Ⅱ型呼吸衰竭患者和40例稳定期慢性阻塞性肺疾病患者随机分组进行研究。检测血浆NT-proBNP水平、动脉血气、急性生理与慢性健康状况评分系统Ⅱ（APACHE II）评分及肺动脉压。比较两组患者血浆NT-proBNP水平。研究NIPPV对AECOPD合并Ⅱ型呼吸衰竭患者NT-proBNP的影响。
所有患者中，NT-proBNP与pH值、NT-proBNP与动脉血氧分压（PaO2）呈负相关（r分别为-0.691、-0.704；P<0.001），NT-proBNP与动脉血二氧化碳分压（PaCO2）、NT-proBNP与APACHE II评分呈正相关（r分别为0.774、0.810，P<0.001），NT-proBNP与肺动脉压（PAP）呈正相关（r=0.965，P<0.001）。在AECOPD合并Ⅱ型呼吸衰竭患者中，NT-proBNP与pH值、NT-proBNP与PaO2呈负相关（r分别为-0.636、-0.616；P<0.001）；NT-proBNP与PaCO2、NT-proBNP与APACHE II评分呈正相关（r分别为0.545、0.475；P=0.001、P=0.002）；NT-proBNP与肺动脉压呈正相关（r=0.833，P<0.001）。AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平显著高于对照组[（939.60±250.00）pg/mL比（151.55±111.20）pg/mL；P<0.01]。NIPPV可降低AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平[（229.15±98.26）pg/mL比（939.60±250.00）pg/mL；P<0.01]，并改善动脉血气及APACHE II评分。虽然NIPPV似乎使治疗前、后组间肺动脉压有所下降，但差异无统计学意义（P=0.056）。
血浆NT-proBNP水平反映AECOPD合并Ⅱ型呼吸衰竭患者的病情严重程度。NIPPV可降低患者血浆NT-proBNP水平，对评估NIPPV的疗效有临床价值。
