The Changes And Signficance Of NT-pro BNP,Coagulation Function And Blood Gas Analysis In Acute Exacerbations Of Chronic Pulmonary Heart Disease

Objective:To analyze the level of NT-proBNP,coagulation function and the results of correlative arteries blood gas analysis in patients with AECPHD,on purpose to study the change and clinic significance of NT-proBNP,coagulation function and arteries blood gas analysis in patients with AECPHD,and providing the theory basis for early clinical diagnosis of the severity and treatment effect in patients with AECPHD.Methods:40 patients with AECPHD?group A?treated in department of respiratory medicine,Xi'an Central Hospital Affiliated to Xi'an Jiao Tong University in June,2017-January,2018 were chosen:25 males,15 females,the age 51-98,the average age69.10±10.61,which all conforms to the eighth edition of"Internal Medicine"about CPHD and its staging diagnosis standard.Meanwhile,not considering that malignant tumors,blood system diseases and patients with severe liver and kidney dysfunction,and patients who used antiplatelet,anticoagulation drugs within recent days;After routine treatment,the patient's symptoms,physical signs and laboratory examination improved significantly and the condition was stable as the diagnostic criteria for the remission group?group B?.40 examples were chosen in June,2017-January,2018,in our outpatients service health physical examination?group C?,23 males,17 females,the age50-84,the average age 69.88±10.33.Measured NT-proBNP,coagulation function and arterial blood gas analysis in group A and B when patients were in hospital within 24hours and on the day or the previous day after stable discharge;Measured NT-proBNP,coagulation function in group C,during the physical examination.Meanwhile,analysis results and making comparisons.Results:1.The concentration of NT-proBNP was significantly increased in patients with AECPHD:NT-proBNP concentration is?1105.60±664.66?pg/ml in group A,obviously higher than?319.65±216.89?pg/ml in group B and?138.08±105.88?pg/ml in group C,there was statistically difference in the NT-proBNPs among the three groups?P<0.05?.2.APTT,PT,FIB and D-dimer in patients with AECPHD obviously increased,but TT has a little change:APTT in group A is?34.55±6.93?s,obviously different with?30.50±4.64?s in group C?P<0.05?,however,APTT was no significance between group A and group B?33.30±7.17?s,and group B and group C?P>0.05?.PT in group A is?13.46±2.74?s,obviously different with?12.25±1.23?s in group B and?11.67±0.72?s in group C?P<0.05?,but there was no significance between group B and group C?P>0.05?.FIB concentration in group A?4.58±1.14?g/L is obviously different with?3.15±0.55?g/L in group B and?2.77±0.56?g/L in group C,but FIB concentration was no significance between group B and group C?P>0.05?.TT in group A is?18.11±2.43?s,?17.87±1.70?s in group B and?18.11±2.43?s in group C,but the result were not statistically significant between the three groups?P>0.05?.The level of D-dimer is?2.23±1.85?mg/L in group A,was significantly higher than?0.78±0.35?mg/L in group B,and?0.34±0.17?mg/L in group C,there was statistically difference in the D-dimers among the three groups?P<0.05?.3.The level of pH and PaO₂ in patients with AECPHD is obviously lower than group B,on the contrary,PaCO₂ concentration is obviously higher than group B:the pH value of is 7.34±0.07,PaO₂ is?48.20±9.06?mmHg,PaCO₂ is?68.10±13.48?mmHg in group A;the pH value of is 7.43±0.05,PaO₂ is?69.68±8.50?mmHg,PaCO₂ is?47.05±10.76?mmHg in group B,There were obviously different between two groups?P<0.05?.4.The increase of NT-proBNP,FIB and D-dimer in AECPHD patients was correlated with the decrease of PaCO₂ and the increase of PaCO₂:patients with AECPHD in group A,PaCO₂ offers significant positive correlation with NT-proBNP,FIB,and D-dimer,and relativity coefficient is 0.667,0.406 and 0.355?P<0.05?;PaO₂ offers significant negative correlation with NT-proBNP,FIB,and D-dimer,and relativity coefficient is-0.364,-0.317 and-0.374,respectively?P<0.05?.5.NT-proBNP,FIB and D-dimer can be used as early indicators to determine the severity of AECPHD patients,and NT-proBNP has the highest diagnostic efficacy:The Area under the ROC curve of plasma NT-proBNP in group A was 0.996?95%CI:0.988-1?.Using a cut off point of 346 pg/ml,which had a sensitivity of 100%,a specificity of 95%?P<0.05?;AUC of plasma D-dimer is 0.990?95%CI:0.970-1?.Using a cut off of 0.73mg/L,which had a sensitivity of 97.5%,a specificity of 95%?P<0.05?;The AUC of plasma FIB was 0.954?95%CI:0.914-0.995?.Using a cut off of 3.245 g/L,which had a sensitivity of 92.5%,a specificity of 82.5%?P<0.05?.Conclusion:1.The level of NT-proBNP,APTT,PT,FIB,D-dimer,PaCO₂ in the AECPHD group were significantly higher than in the remission group and the healthy control group,the pH and PaO₂ levels were significantly reduced,the TT levels has a little change,which indicates that patients with AECPHD can also suffer from cardiac dysfunction,coagulation dysfunction and respiratory dysfunction.2.The increase degree of NT-proBNP,FIB,and D-dimer which is significantly correlated with the decrease of PaO₂ and the increase degree of PaCO₂,which indicates that the cardiac dysfunction and coagulation dysfunction patients with AECPHD had a close relationship with respiratory dysfunction.3.The NT-proBNP,FIB and D-dimer level changes has some diagnostic value in judging early clinical diagnosis of the severity of the disease and treatment effect in patients with AECPHD,and the NT-proBNP was considered as the best biomarker which have the highest diagnostic efficiency.