慢性阻塞性肺疾病并发肺动脉高压血清标志物研究

目的探讨慢性阻塞性肺疾病(慢阻肺)患者血清中C反应蛋白(CRP)、内皮素-1(ET-1)、N端-前脑钠肽(NT-PROBNP)和血管内皮生长因子(VEGF)水平与肺动脉收缩压(PASP)之间的关系。方法研究对象来源于南京医科大学附属淮安一院呼吸内科2012年1月-2015年6月收治的286例慢阻肺急性加重期患者。按肺动脉收缩压升高程度分为轻度、中度和重度。采用ELISA试剂盒检测各血清学CRP、ET-1、NT-PROBNP和VEGF的水平。结果 CRP和ET-1在慢阻肺并发肺动脉高压(PAH)组患者均较单纯慢阻肺组升高(P0.05),慢阻肺并发轻、中度PAH时,CRP和ET-1水平升高与肺动脉压力呈显著正相关性(P0.05);慢阻肺并发轻、中和重度PAH时,NT-PROBNP水平较单纯慢阻肺组升高,并且与肺动脉压力呈显著正相关性(P0.05);慢阻肺并发肺动脉轻度和中度升高时,VEGF水平均较单纯慢阻肺组升高(P0.05),慢阻肺合并肺动脉重度升高时,VEGF水平反而较轻度和中度升高组明显降低(P0.05)。结论联合监测CRP、ET-1、NT-PROBNP和VEGF,对于预判慢阻肺患者肺动脉压力的升高及其程度,慢阻肺继发性PAH的早期诊断和预后判断有着重要的临床意义。

Study of serum marker in patients with pulmonary hypertension secondary to chronic obstructive pul-monary disease

Objective To explore the correlation of the changes in serum markers C-reactive protein (CRP), N-terminal brain natriuretic peptide( NT-PROBNP), endothelin-1 (ET-1), and vascular endothelial growth factor (VEGF) with only chronic obstructive pulmonary disease (COPD) and pulmonary hypertension secondary to COPD. Methods 286 patients with AECOPD from January 2012 to June 2015 in Huai'an First People' s Hospital Affiliated to Nanjing Medical University were divided into the mild, moderate and severe groups according to pulmo-nary arterial systolic pressure ( PASP) . The levels of serum markers were determined using ELISA kits. Results The CRP and ET-1 levels in patients with mild and moderate PASP were significantly elevated compared with only COPD patients (P<0. 05). There were significant positive correlations between CRP, ET-1 level and PASP (P<0. 05). The NT-PROBNP level in patients with mild and moderate and high PASP were all significantly elevated com-pared with only COPD patients (P<0. 05). There was a significant positive correlation between BNP level and PASP (P<0. 05). The VEGF level in patients with mild and moderate PASP were significantly elevated compared with on-ly COPD patients (P<0. 05). The VEGF level in patients with high PASP was significantly decreased compared with mild and moderate PASP patients (P<0. 05). Conclusion Early and combined examination of CRP, ET-1, NT-PROBNP and VEGF in patients with COPD have good effect in evaluating PASP, which is of great importance in eval-uation of the prognosis of pulmonary hypertension secondary to COPD.