Hawkins Nathaniel M, Khosla Amit, Virani Sean A, McMurray John J V, FitzGerald J Mark
Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
BMC Pulm Med. 2017 Jan 10;17(1):11. doi: 10.1186/s12890-016-0345-7.
Patients with chronic obstructive pulmonary disease (COPD) have increased cardiovascular risk. Natriuretic peptides (NP) in other populations are useful in identifying cardiovascular disease, stratifying risk, and guiding therapy.
We performed a systematic literature review to examine NP in COPD, utilising Medline, EMBASE, and the Cochrane Library.
Fifty one studies were identified. NP levels were lower in stable compared to exacerbation of COPD, and significantly increased with concomitant left ventricular systolic dysfunction or cor pulmonale. Elevation occurred in 16 to 60% of exacerbations and persisted in approximately one half of patients at discharge. Cardiovascular comorbidities were associated with increased levels. Levels consistently correlated with pulmonary artery pressure and left ventricular ejection fraction, but not pulmonary function or oxygen saturation. NP demonstrated high negative predictive values (0.80 to 0.98) to exclude left ventricular dysfunction in both stable and exacerbation of COPD, but relatively low positive predictive values. NP elevation predicted early adverse outcomes, but the association with long term mortality was inconsistent.
NP reflect diverse aspects of the cardiopulmonary continuum which limits utility when applied in isolation. Strategies integrating NP with additional variables, biomarkers and imaging require further investigation.
慢性阻塞性肺疾病（COPD）患者心血管风险增加。其他人群中的利钠肽（NP）有助于识别心血管疾病、分层风险和指导治疗。
我们利用Medline、EMBASE和Cochrane图书馆进行了一项系统的文献综述，以研究COPD中的NP。
共识别出51项研究。与COPD加重期相比，稳定期NP水平较低，且随着合并左心室收缩功能障碍或肺心病而显著升高。16%至60%的加重期出现NP升高，约一半患者出院时仍持续升高。心血管合并症与NP水平升高有关。NP水平始终与肺动脉压和左心室射血分数相关，但与肺功能或血氧饱和度无关。NP在COPD稳定期和加重期排除左心室功能障碍方面显示出较高的阴性预测值（0.80至0.98），但阳性预测值相对较低。NP升高可预测早期不良结局，但与长期死亡率的关联并不一致。
NP反映了心肺连续体的多个方面，单独应用时其效用有限。将NP与其他变量、生物标志物和影像学相结合的策略需要进一步研究。
