Objective: To determine the diagnosis value and therapy significance of peripheral blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in pneumoconiosis patients with chronic pulmonary heart disease (CPHD) . Methods: A total of 22 pneumoconiosis complicated with CPHD (A group) , 20 pneumoconiosis complicated with coronary heart disease (B group) and 25 pneumoconiosis without heart disease (C group) were selected. The level of blood NT-proBNP was examined and analyzed in the three groups. We observed the difference blood level of NT-proBNP concentration between before and after of therapy in pneumoconiosis patients with CPHD. The optimal cutoff value of blood NT-proBNP was determined according to the principle of maximum Youden's index associated with clinical analysis. Results: Blood NT-proBNP concentrations were 543.19±78.92, 1017.38±731.06, 109.56±57.46 pg/ml in three groups, respectively. Compared with C group, there was a significant increase in the blood levels of NT-proBNP in both A and B groups (P<0.05, P<0.01) , especially for B group. Compared with NT-proBNP 543.19±78.92 pg/ml before therapy, the153.34±58.40 pg/ml was significantly declined after therapy in B group (P<0.05) . The optional threshold for peripheral blood NT-proBNP level as a diagnostic indicator for pneumoconiosis complicated with CPHD was 450 pg/ml. The specificity and sensitivity of NT-proBNP were 95.46% and 54.17%, respectively. Conclusion: Blood NT-proBNP level may be useful as a tool for monitoring the effect of pneumoconiosis patients with CPHD treatment with higher sensitivity in. Blood NT-proBNP cut-off >450 pg/ml should be applied in clinical practice as a valuable diagnostic prediction for pneumoconiosis patients with CPHD.
目的： 探讨静脉血N端B型钠尿肽前体（NT-proBNP）在尘肺并发慢性肺心病患者诊断中的预测界值及临床治疗的意义。 方法： 于2018年1月，选择2016年10月至2017年10月在山东省职防院确诊的尘肺并发慢性肺心病（简称"肺心病组"）患者22例，尘肺并发冠心病（简称"冠心病组"）患者20例，尘肺无并发症（简称"无并发症组"）患者25例。测定患者静脉血NT-proBNP，观察尘肺并发慢性肺心病患者治疗前后NT-proBNP变化。依据Youden指数最大原则并结合临床分析，确定NT-proBNP的临界值。 结果： 3组患者静脉血NT-proBNP分别为（543.19±78.92）、（1017.38± 731.06）和（109.56±57.46）pg/ml，与无并发症组比较，肺心病组、冠心病组患者静脉血NT-proBNP水平均明显增高，差异有统计学意义（P<0.05），冠心病组患者静脉血NT-proBNP水平增高更为明显。肺心病组患者治疗前、后静脉血NT-proBNP分别为（543.19±78.92）和（153.34±58.40）pg/ml，与治疗前比较，治疗后患者静脉血NT-proBNP水平有明显降低，差异有统计学意义（P<0.01）。患者静脉血NT-proBNP临界值为450 pg/ml，特异度为95.46%，敏感性为54.17%。 结论： 血BNP水平是尘肺并发慢性肺心病治疗效果监测的敏感指标。建议以NT-proBNP >450 pg/ml作为尘肺并发慢性肺心病右心功能不全的早期诊断界值。.
Keywords: N-terminal pro-B-type natriuretic peptide; Pneumoconiosis; Pulmonary heart disease.