【摘要】 目的 探究N-末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)、D-二聚体(D-dimer, D-D)、肌酸激酶同工酶(creatine kinase isoenzyme, CK-MB)活性与慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并肺源性心脏病患者肺动脉收缩压、心功能的相关性。方法 回顾性分析2020年4月～2025年4月大庆市人民医院收治的81例COPD合并肺源性心脏病患者临床资料，根据纽约心脏病协会(New York Heart Association, NYHA)分级将患者分为Ⅰ～Ⅱ级组(n=33)、Ⅲ～Ⅳ级组(n=48),统计患者NT-proBNP、D-D、CK-MB、肺动脉收缩压及临床资料，比较两组患者的NT-proBNP、D-D、CK-MB、肺动脉收缩压。采用Pearson相关性分析COPD合并肺源性心脏病患者NT-proBNP、D-D、CK-MB与肺动脉收缩压的关系。绘制受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)分析3种指标对患者肺动脉收缩压的预测效能。结果 Ⅰ～Ⅱ级组NT-proBNP、D-D、CK-MB水平均低于Ⅲ～Ⅳ级组(P<0.05);81例患者平均肺动脉收缩压为(59.96±10.69)mmHg,其中轻度升高、中度升高、重度升高分别为16例、51例、14例；Pearson相关性分析结果显示，NT-proBNP、D-D、CK-MB水平与肺动脉收缩压均呈正相关(P<0.05);ROC曲线分析结果显示，NT-proBNP、D-D、CK-MB预测COPD合并肺源性心脏病患者肺动脉高压的曲线下面积值(area under the curve, AUC)分别为0.788、0.740、0.710,以NT-proBNP的AUC最高，敏感度、特异度分别为70.77%、93.75%。结论 NT-proBNP、D-D、CK-MB水平与COPD合并肺源性心脏病患者心功能、肺动脉收缩压存在显著相关性。三种指标对于COPD合并肺源性心脏病肺动脉高压具有良好的预测效能。更多还原

【Abstract】 Objective To investigate the correlation between N-terminal pro-brain natriuretic peptide(NT-proBNP), D-dimer(D-D), creatine kinase isoenzyme(CK-MB) activity and pulmonary artery systolic pressure, cardiac function in patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary heart disease. Methods The clinical data of 81 patients with COPD and pulmonary heart disease admitted to the Daqing People’s Hospital from April 2020 to April 2025 were reviewed. According to the New York Heart Association(NYHA) classification, the patients were divided into grades Ⅰ～Ⅱ group(n=33) and grades Ⅲ～Ⅳ group(n=48). NT-proBNP, D-D, CK-MB and pulmonary artery systolic pressure were compared between the two groups. Pearson’s correlation was used to analyze the relationship between NT-proBNP, D-D, CK-MB and pulmonary artery systolic pressure in patients with COPD complicated with pulmonary heart disease. The receiver operating characteristic(ROC) curves were used to analyze the predictive efficacy of the three indicators for pulmonary artery systolic pressure. Results The levels of NT-proBNP, D-D, and CK-MB in grades Ⅰ～Ⅱ group were lower than those in grades Ⅲ～Ⅳ group(P<0.05). The average pulmonary artery systolic pressure of the 81 patients was(59.96±10.69)mmHg, with 16 cases showing mild elevation, 51 cases showing moderate elevation, and 14 cases showing severe elevation. Pearson’s correlation analysis results showed that the levels of NT-proBNP, D-D and CK-MB were positively correlated with pulmonary artery systolic pressure(P<0.05). ROC curve analysis results showed that the area under the curve(AUC) values of NT-proBNP, D-D, and CK-MB for predicting pulmonary artery hypertension in patients with COPD and pulmonary heart disease were 0.788, 0.740, and 0.710, respectively. The AUC of NT-proBNP was the largest. Its sensitivity and specificity were 70.77% and 93.75%, respectively. Conclusion There is a significant correlation between NT-proBNP, D-D,CK-MB levels and cardiac function, pulmonary artery systolic pressure in patients with COPD complicated with pulmonary heart disease. The three indicators demonstrates good predictive efficacy for pulmonary artery hypertension in patients with COPD and pulmonary heart disease.更多还原