The Diagnosis Value Of Plasma N-Terminal Pro-Brain Natriuretic Peptide In Chronic Obstructive Pulmonary Disease Combined With Chronic Pulmonary Heart Disease

Objective We adopt prospective study to determine the value of plasma N-Terminal Pro-Brain Natriuretic Peptide(NT-Pro BNP) in different stage of acute exacerbations of Chronic obstructive pulmonary disease(COPD) combined with Chronic pulmonary heart disease.Methods The 319 participants were collected from our hostiptal, they were grouped as the followings: 48 healthy controls, 96 patients with simple COPD(50 patients with acute exacerbations of COPD and 46 patients with stable COPD; respectively),98 patients with Chronic heart disease due to COPD(41 patients with Chronic pulmonary heart disease in compensatory stage and 47 patients with Chronic pulmonary heart disease with right heart failure; respectively),48 patients with left heart failure alone and 39 patients with whole heart failure. Participants’ NT-Pro BNP was measured in the first 24 hours, the pulmonary function test, heart doppler ultrasound and renal function test were implemented in the first 48-72 hours. The difference of plasmal NT-Pro BNP levels between above groups was compared. Pearson correlation analysis were used to identify significant relationships between NT-pro BNP and variables of interest. The optimal cut-off value was obtained from Receiver operating characteristic curve analysis.Results(1).The plasma NT-pro BNP level in acute exacerbations of COPD was much higher than that in stable COPD(P<0.001). The plasmal NT-pro BNP level in chronic pulmonary heart disease in compensatory stage was increased more dramatically than those in the acute exacerbations COPD(P<0.001). The plasmal NT-pro BNP level in chronic pulmonary heart disease with right heart failure rised more significantly than that in the chronic pulmonary heart disease in conpensatory stage(P<0.001). The plasmal NT-pro BNP level in patients with left heart failure was increased markedly as compared with that in the patients with Chronic pulmonary heart disease(P<0.001).(2).In the Chronic pulmonary heart disease group, there was a positivecorrelation between plasmal NT-pro BNP and RV, RVOT, PASP,Urea, Cre; However, the plasmal NT-pro BNP level was negatively correlated with FEV1%, None correlation was found between the plasmal NT-pro BNP level and LVEF%。In the groups of left heart failure and whole heart failure, the plasmal NT-pro BNP level was positively correlated with Urea and Cre, but has negatively correlated with LVEF%.(3).The optimal cut off value of NT-pro BNP level that was used to diagnosis acute exacerbations COPD and Chronic pulmonary heart disease in conpensatory stage was 638.52 pg/ml. The area under curve(AUC) was 0.814. Meanwhile, The optimal cut off value of NT-pro BNP level that was used to diagnosis Chronic pulmonary heart disease in conpensatory stage and Chronic pulmonary heart disease with right heart failure, Chronic pulmonary heart disease with right heart failure and whole heart failure were 1005.6 pg/ml and 3524.3 pg/ml, the AUC were 0.861 and 0.855, respectively.Conclusion1. The plasmal NT-pro BNP level in patients with Acute exacerbation COPD was higher than that in stable COPD,the plasmal NT-pro BNP level in patients with Chronic pulmonary heart disease was increased significantly than that in patients with COPD. The plasmal NT-pro BNP level was correlated with the clinical stage of Chronic pulmonary heart disease. dynamic monitor the plasmal NT-pro BNP level was useful to make a diagnosis and treatment to patients with Chronic pulmonary heart disease.2.The plasmal NT-pro BNP level may be a fast and noninvasive indicater to evaluate condition of patients with Chronic pulmonary heart disease due to the certain correlation between plasmal NT-pro BNP level and FEV1, RV, RVOT, PASP, Urea and Cre.3. The optimal cut-off value was established by ROC curve analysis, and could be used as a diagnostic indicater in patients with Chronic pulmonary heart disease, Chronic pulmonary heart disease in compensatory stage and Chronic heart disease combined with right heart failure.