| Objective : To observe the expression level of serum brain natriuretic peptide(BNP)in patients with decompensation stage of chronic obstructive pulmonary heart disease,coronary heart disease and dilated heart failure.Methods : From August 2015 to August 2016,180 patients in the Department of respiratory medicine and cardiology of Shao Yang City Central Hospital were enrolled in this study.There were 98 males and 82 females.According to the etiology of heart failure,there were 57 cases in decompensation stage of chronic obstructive pulmonary heart disease,61 cases in coronary heart failure group and 62 cases in dilated heart failure group.Before and after admission,the BNP levels in serum were tested,and the left ventricular end-diastolic diameter,left ventricular ejection fraction and right ventricular outflow tract were tested by color Doppler echocardiography.The differences of serum BNP levels and each index among the above groups were compared,and the correlation analysis was carried out,and the ROC curves of different groups were drawn to obtainthe best cut point.Results:1.A total of 180 patients with heart failure were diagnosed,including 57 patients in decompensated stage of decompensation stage of chronic obstructive pulmonary heart disease,61 patients in coronary heart failure group and 62 patients in dilated heart failure group.There were significant differences in BNP level,left ventricular end-diastolic diameter,left ventricular ejection fraction and right ventricular outflow tract diameter between the three groups before treatment(P < 0.001).Among them,there was significant difference between BNP group and pairwise group(P<0.05).The level of serum BNP in decompensated cor pulmonale group was relatively lower than that in coronary heart failure group(t=6.371,P<0.001)and dilated heart failure group(t= 8.145,P<0.001).The level of serum BNP in coronary heart failure group was lower than that in dilated heart failure group(t= 5.024,P<0.001).2.There was significant difference in serum BNP between the three groups before and after treatment(P<0.05).In the decompensated group of cor pulmonale,the serum BNP value was 490.36±84.98pg/ml before treatment,101.77 ± 12.84pg/ml after treatment(t=7.583,P < 0.001),798.63±9481pg/ml in coronary heart failure group,267.65±14.72pg/ml(t=9.852,P < 0.001)after treatment,and the serum BNP value in coronary heart failure group was 798.63 ± 9481pg/ml,and that in coronary heart failure group was 267.65 ± 14.72pg/ml(t=9.852,P <0.001).In the heart failure group,the serum BNP value was 1063.67 ±199.11 pg/ml before treatment and 351.17±14.24pg/ml after treatment(t= 11.439,P<0.001).3.Pearson correlation analysis showed that BNP level was positively correlated with left ventricular end-diastolic diameter and right ventricular outflow tract diameter,and negatively correlated with left ventricular ejection fraction.In pulmonary heart disease decompensated period group,BNP level was positively correlated with right ventricular outflow tract diameter(r=0.77,P < 0.05),but not with left ventricular end-diastolic diameter and left ventricular ejection fraction.In the coronary heart disease combined with heart failure group,BNP level was positively correlated with left ventricular end-diastolic diameter(r=0.58,P<0.05),negatively correlated with left ventricular ejection fraction(r=-0.61,P < 0.05),but not with RVOT.In dilated cardiomyopathy group with heart failure,BNP level was positively correlated with left ventricular end-diastolic diameter(r=0.76,P<0.05).There was a positive correlation with left ventricular ejection fraction(r=-0.53,P<0.05).4.The best cut-off value of BNP on diagnosis in the decompensated stage group of cor pulmonale and the group of decompensated cor pulmonale was 614.92pg/ml,the sensitivity was 80.6%,the specificity was 90.3%,the youden index was 0.71,and the area under the curve was0.886,and it was 969.73pg/ml in the coronary heart failure group anddilatation heart failure group,the sensitivity was 82.3%,the specificity was 71.0%,the youden index was 0.533,and the area under the curve was0.768.Conclusion:BNP value is the lowest in cor pulmonale heart failure,followed by coronary heart failure and dilatation heart failure.BNP level provides a certain reference value for the differential etiology of patients with heart failure. |
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