| BackgroundIn recent years, as the growth of the ageing population and people lifestyle and eating habits changing, chronic pulmonary heart disease increased year by year, and it influence patient’s quality of life and ability to work seriously. Due to long-term repeated hypoxemia and respiratory infections, the patients with chronic pulmonary heart disease will lead to heart failure ultimately because of pulmonary hypertension and right ventricular hypertrophy. Although the studies on plasma N-Terminal Pro-Brain Natriuretic peptide(NT-proBNP) and cardiac ultrasound are more and more, but the vast majority concentrated in the diseases on the left cardiac insufficiency and left ventricular enlargement, and the studies on right heart function and right heart enlargement such as chronic pulmonary heart disease are less. In this study, we will analyse the plasma NT-proBNP and right ventricular ejection fraction(RVEF) in patients with chronic pulmonary heart disease during different periods, discuss the changes and its clinical significance in the development of chronic pulmonary heart disease, and provide a new means and a new approach for prevention and control of chronic pulmonary heart disease.ObjectiveThis study was performed to investigate the changes of plasma N-Terminal Pro-Brain Natriuretic peptide(NT-proBNP) and right ventricular ejection fraction(RVEF) in patients with chronic pulmonary heart disease during different periods, the correlation among the clinical stage of chronic pulmonary heart disease, plasma NT-proBNP and RVEF Through the study, we will analyse the value relevance of plasma NT-proBNP and RVEF, clarify the clinical significance of plasma NT-proBNP and RVEF in the diagnosis, condition monitoring and prognosis evaluation.MethodsAccording to the history, symptoms, signs, and objective test results,200patients with chronic pulmonary heart disease were divided into two groups:pulmonary cardiac compensation period group (group A, n=58) and pulmonary cardiac decompensation period group (n=142). The pulmonary cardiac decompensation period were divided into three subgroups again:breathing difficulties group (group B1, n=55), right heart failure group (group B2, n=62) and whole heart failure period group (group B3, n=25). The above groups compared with healthy volunteers (group C,normal control group, n=28). Plasma NT-ProBNP concertration was detected by electrochemical luminescence method within24h, and right ventricular ejection fraction was performed by eachocardiogram with the simpson double plane method within48h. The Changes of plasma NT-ProBNP level and right ventricular ejection fraction were compared among patients of chronic pulmonary heart disease with the control group, pulmonary cardiac compensation period with pulmonary cardiac decompensation period, and different types of pulmonary cardiac decompensation period subgroups. Based on the above research, we will analyse the relationship among plasma NT-proBNP and RVEF, clarify the clinical significance of plasma NT-proBNP and RVEF in the chronic pulmonary heart disease.Results1.Plasma NT-proBNP level in pulmonary cardiac compensation period group was (250.63±61.88)pg/ml. Plasma NT-proBNP level in normal control group was(121.05±20.34)pg/ml. Plasma NT-proBNP level in pulmonary cardiac compensatory period group was obviously higher than that of normal control group (P<0.001).2. Plasma NT-proBNP level in breathing difficulties group was (774.62±488.34) pg/ml. Plasma NT-proBNP level in breathing difficulties group was obviously higher than that of normal control group (P<0.001).3. Plasma NT-proBNP level in right heart failure group was (1569.80±583.07) pg/ml. Plasma NT-proBNP level in right heart failure group was obviously higher than that of breathing difficulties group(P<0.001).4. Plasma NT-proBNP level in whole heart failure period group was (6746.80±4669.10) pg/ml. Plasma NT-proBNP level in whole heart failure period group was obviously higher than that of right heart failure group(P<0.001).5. Plasma NT-proBNP level increased with the development of chronic pulmonary heart disease from pulmonary cardiac compensation period to whole heart failure period (group A to group B3), and there are significant differences during different periods (P<0.001).6. The right ventricular ejection fraction(RVEF) in patients of normal control group, pulmonary cardiac compensation period group, breathing difficulties group, right heart failure group and whole heart failure period group were (62.66±3.54)%,(69.50±4.59)%,(48.60±2.82)%,(45.29±3.87)%,(40.97±5.19)%respectively. The right ventricular ejection fraction increased at first, then reduced with the development of chronic pulmonary heart disease from pulmonary cardiac compensation period to whole heart failure period (group A to group B3). There are significant difference between them (P<0.001).7. The single factor analysis of plasma NT-ProBNP level and RVEF value correlation results show that there was significant negative correlation between plasma NT-proBNP levels and RVEF in the pulmonary cardiac compensation period group, breathing difficulties period group, right heart failure period group and whole heart failure period group.The Pearson correlation coefficient were r=-0.901, r=-0.728, r=-0.881, r=-0.720respectively (all P<0.001)Conclusions1.Plasma NT-proBNP level increased in patients with chronic pulmonary heart disease, and increased more and more with the development of the disease.This suggests that there was correlation between brain natriuretic peptide and the clinical stages of chronic pulmonary heart disease, and brain natriuretic peptide was involved in the pathophysiological process of chronic pulmonary heart disease.2. The right ventricular ejection fraction(RVEF) increase in pulmonary cardiac compensation period, and it gradually reduced in pulmonary cardiac decompensation period with the development of chronic pulmonary heart disease.3. There was significant negative correlation between plasma NT-proBNP levels and RVEF in patients with chronic pulmonary heart disease during different periods.4. The detection of plasma NT-proBNP and right ventricular ejection fraction is helpful to the early diagnosis and disease forecast in patients with chronic pulmonary heart disease during different periods, and it can be used as important reference indexes of curative effect evaluation and prognostic judgement in patients with chronic pulmonary heart disease. |
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