| Backgroud The pulmonary function decline progressively in chronic obstructive pulmonary disease(COPD) patients with recurrent acute exacerbations, and the patients gradually developed into pulmonary heart disease(PHD), endangering their labor force and quality of life seriously. Secondary pulmonary artery hypertension (PAH) is the key point in COPD progression to PHD, so early diagnosis and intervention for secondary pulmonary hypertension in patients with COPD have important clinical significance. The determination of PAH in current clinical is mainly dependent on the echocardiography, so choosing a more simple and efficient marker to assess the level of PAH will do help in clinical prevention and treatment of COPD and pulmonary heart disease. B-type natriuretic peptide is synthesised and secreted constitutively by the ventricles, which increasing significantly in pathophysiological conditions, such as heart failure, myocardial infarction and severe pulmonary embolism. In recent years, it has been reported that plasma BNP correlated with high-sensitivity C-reactive protein (Hs-CRP) and arterial oxygen pressure (PaO2) in patients with cyanotic congenital heart disease. Another study also found that plasma BNP levels in patients with pneumonia significantly correlated with C-reactive protein. Therefore, this study explores the relationship between plasma BNP and pulmonary artery systolic pressure(PASP), Hs-CRP, PaO2 in acute exacerbation of chronic obstructive pulmonary disease (AECOPD)Objective To observe the level of plasma BNP and analyze the correlation between BNP and PASP in AECOPD accompanied with PAH. At the same time, the level of Hs-CRP, PaO2 were observed and the relevance of Hs-CRP, PaO2 and PASP, the correlation between BNP and Hs-CRP, PaO2 were analyzed. Then to investigate the clinical significance of BNP, Hs-CRP in AECOPD patients accompanied with PAH.Methods 80 impatients due to acute exacerbation of COPD were selected from Jan 2009 to Jun 2010, their plasma BNP, PASP, Hs-CRP, PaO2 and end-systolic right ventricular/left ventricular diameter ratio (RVDs/LVDs) were detected. In accordance with 2009 European Society of Cardiology (ESC) guidelines, PASP measured value is divided into three groups based on echocardiographic:normal pulmonary artery pressure group, mild PAH group and moderate to severe PAH group. Using chi-square test, ANOVA and q test to analyze these three sets of data. The level of BNP, Hs-CRP, PaO2, RVDs/LVDs were compared among three groups of patients, and the relevance of Hs-CRP, PaO2 and PASP were analyzed. And the correlation between BNP and PASP, Hs-CRP, PaO2 were investigated. Statistical software is SPSS 13.0, P<0.05 was considered statistically significant.Results This study enrolled 80 cases of patients with AECOPD, according to PASP values which were divided into normal pulmonary artery pressure group with 19 patients, the average PASP was 25.84±2.27mmHg; mild pulmonary artery hypertension group with 37 patients, the mean PASP was 44.59±3.27mmHg; moderate to severe pulmonary artery hypertension group with 24 patients, the mean PASP was 67.46±12.44mmHg. The results show:1.BNP in the normal pulmonary artery pressure group was 54.54±11.58pg/ml, mild pulmonary artery hypertension group 142.37±27.72pg/ml, moderate to severe pulmonary artery hypertension group 191.12±45.82pg/ml. Along with the pulmonary artery pressure increased higher, BNP increased more obviously. Pairwise comparison among the three groups, P<0.05, the difference was statistically significant.2. Hs-CRP in the normal pulmonary artery pressure group was 2.14±0.81mg/L, mild pulmonary artery hypertension group 8.87±1.20mg/L, moderate to severe pulmonary artery hypertension group 12.06±2.01mg/L. With the pulmonary artery pressure increased, Hs-CRP levels also rose significantly. Pairwise comparison among the three groups, P<0.05, the difference was statistically significant.3.PaO2 in the normal pulmonary artery pressure group was 88.05±8.13mmHg, mild pulmonary artery hypertension group 63.67±9.58mmHg, moderate to severe pulmonary artery hypertension group 56.62±8.27mmHg. With the increasing of pulmonary artery pressure, PaO2 decreased more obviously. Pairwise comparison among the three groups, P<0.05, the difference was statistically significant.4.RVDs and RVDs/LVDs in the normal pulmonary artery pressure group was 15.11±3.26mm and 0.51±0.14, mild pulmonary artery hypertension group was 19.16±3.10mm and 0.64±0.13, moderate to severe pulmonary artery hypertension group was 22.13±2.83mm and 0.74±0.12. With the pulmonary artery pressure increased significantly, RVDs and RVDs/LVDs increased more obviously. Pairwise comparison among the three groups, P<0.05, the difference was statistically significant.5.The correlation analysis of BNP and PASP、Hs-CRP、PaO2 showed that plasma BNP and PASP was positively correlated(r=0.795, P <0.01); plasma BNP and Hs-CRP was positively correlated(r=0.776, P<0.01); and BNP negatively correlated with PaO2 (r=-0.67, P<0.01).6.The correlation analysis of Hs-CRP and PASP, PaO2 showed that Hs-CRP was positively correlated with PASP(r=0.852, P <0.01); Hs-CRP was negatively correlated with PaO2(r=-0.731, P<0.01).7. The correlation analysis of PaO2 and PASP showed that PaO2 and PASP was negatively correlated(r=-0.695, P<0.01).Conclusion In AECOPD patients, the level of BNP was positively correlated with PASP; with the more increasing of PASP, the more obvious elevation of BNP. Along with the increase of PASP and BNP, Hs-CRP and hypoxemia also increased significantly. And the level of BNP was positively correlated with Hs-CRP, negatively correlated with PaO2. Therefore, the plasma BNP combined with above indicators, can contribute to provide valuble clinical information in diagnosis and treatment of COPD accompanied with PAH. |
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