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BNP升高的AECOPD患者的心血管超声变化分析
作者:苏建花1  朱婷2  石宝平1  包婺平3  程克文1 
单位:1. 上海市宝山区仁和医院 呼吸科, 上海 200431;
2. 上海市宝山区仁和医院 超声科, 上海 200431;
3. 上海交通大学附属第一人民医院 呼吸科, 上海 200080
关键词:慢性阻塞性肺疾病 脑钠肽 超声心动图 颈部血管超声 
分类号:R563.5
出版年·卷·期(页码):2020·39·第一期(61-64)
摘要:

目的: 了解慢性阻塞性疾病急性加重期(AECOPD)合并不同水平脑钠肽(BNP)升高患者的心血管超声变化,并探讨其临床意义。方法: 纳入BNP升高的AECOPD患者,按BNP水平分为组1(BNP 100~400 ng·L-1)和组2(BNP>400 ng·L-1),收集两组患者之间超声心动图、颈部血管超声结果并做组间比较。方法: 共151例入组患者。组2患者右心室内径(RVID)、左心房内径(LAD)、肺动脉收缩压(PASP)显著高于组1(P均<0.05),左室射血分数(LVEF)显著低于组1(P<0.05)。主动脉根部内径(AORD),舒张末期左心室内径(LVIDd),收缩末期左心室内径(LVIDs)两组间无显著差异(P均>0.05)。组2患者双侧颈总和颈内血流峰数速均低于组1(P均<0.05)。双侧颈部血管发生内膜毛糙增厚、内膜斑块的比率两组间无显著差异(P均>0.05)。方法: BNP升高的AECOPD患者,尤其是BNP高于400 ng·L-1的患者容易伴随心脏增大,肺动脉收缩压升高,左心室射血分数降低,颈部血流减慢。临床应给予更多关注,重视心血管超声评估,从而及时且全面地了解患者的心血管储备功能,带来更准确的个体化治疗和临床获益。

Objective: To investigate the abnormalcardiovascular ultrasound results in patients diagnosed with acute exacerbation chronic obstructive pulmonary disease (AECOPD) combined with elevated brain natriuretic peptide (BNP), and to discuss the clinical significance of cardiovascular dysfunction. Methods: According to the level of BNP, AECOPD patients were divided into Group 1 (BNP 100-400 ng·L-1) and Group 2 (BNP> 400 ng·L-1). Echocardiogram and cervical vascular ultrasound results were collected and compared between the two groups. Results: Totally, 151 subjects were included. The right ventricular internal diameter (RVID), left arterial diameter (LAD), pulmonary arterial systolic pressure (PASP) of Group 2 were significantly higher than those of Group 1 (P<0.05 for all), and the left ventricular ejection fraction (LVEF) was significantly lower than that of Group 1 (P<0.05). There were no significant inter-group differences of the aortic root inside diameter (AORD), the left ventricular end-diastolic diameter (LVIDd), and the left ventricular end-systolic diameter (LVIDs) (P>0.05 for all). The peak values of bilateral total blood flow and internal carotid blood flow in Group 2 were lower than those in Group 1 (both P<0.05). No significant differences between the two groups were found in bilateral cervical vascular intimal thickening and rough intima plaque incidence (both P>0.05). Conclusion: Patients suffered from AECOPD combined with elevated BNP, especially those with BNP higher than 400 ng·L-1 are more frequently associated with cardiac enlargement, increased pulmonary arterial pressure, lower ejection fraction, and lower neck blood flow. More attention should be paid to the clinic, and the evaluation of cardiovascular ultrasound should be performed, so as to timely and comprehensively understand the cardiovascular reserve function of the patient, which brings more accurate individual treatment and clinical benefit.

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