Диагностическая и прогностическая значимость концевого N-отрезка мозгового натрийуретического пептида (Nt-proBNP) при обострении хронической обструктивной болезни легких

Резюме. Натрийуретические пептиды являются маркером сердечной недостаточности. Известна роль натрийуретического пептида NT-proBNP в качестве предиктора прогноза при критических состояниях.

Целью исследования была оценка диагностического и прогностического значения NT-proBNP у больных с обострением хронической обструктивной болезни легких (ХОБЛ). Исследование носило открытый проспективный дизайн. Были обследованы 80 госпитализированных пациентов с обострением ХОБЛ (возраст – 65,8 ± 19,9 года; объем форсированного выдоха за 1-ю с (ОФВ1) – 38,5 ± 17,3 %; парциальное напряжение кислорода (PaO2) и углекислого газа (PaCO2) – 53,8 ± 13,0 мм рт. ст. и 50,6 ± 15,1 мм рт. ст. соответственно). Всем пациентам выполнялось комплексное обследование (рентгенография легких, спирография, эхокардиография и серийные измерения уровня плазменного NT-proBNP). Основными причинами обострения ХОБЛ были гнойный бактериальный бронхит (48,8 %), пневмония (23,8 %), декомпенсация хронической сердечной недостаточности – ХСН (17,5 %) и тромбоэмболия легочных артерий – ТЭЛА (5 %). Уровень NT-proBNP был повышен у 88,7 % больных с обострением ХОБЛ, средняя концентрация NT-proBNP составила 1 057,8 ± 555,3 фмоль / мл. Пациенты с ХОБЛ и ТЭЛА имели самый высокий уровень NT-proBNP (1 735,9 ± 523,8 фмоль / мл); у пациентов с сочетанием ХОБЛ и ХСН уровень NT-proBNP – 1 405,4 ± 626,8 фмоль / мл, с пневмонией – 1 043,5 ± 643,1 фмоль / мл, с гнойным бронхитом – 906,6 ± 425,9 фмоль / мл. Значения Nt-pro BNP были выше у умерших, по сравнению с выжившими больными (1 484,6 ± 618,7 vs 1 003,7 ± 527,1 фмоль / мл соответственно; p = 0,013). Таким образом, у больных с обострением ХОБЛ плазменный уровень Nt-proBNP являлся эффективным маркером тяжести и прогноза болезни.

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