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Рецензент: д.мед.н., проф. Ю.Г. Бурмак
УДК 616.24-007.272-036.1-07 :616.127]-085.276+615.23
Харьковская медицинская академия последипломного образования
Kharkov medical academy of Postgraduate Education
61176, Kharkov, 58 str.Korchahyntsev
The aim of research consisted of studying of levels of brain natriuretic peptide (ВNP) in relation with frequency of exacerbations and the degree of airflow limitation in patients with chronic obstructive pulmonary disease. 120 patients took part in the research that were on stationary treatment concerning exacerbation of COPD in the Kharkiv municipal pulmonology center; COPD of II stage was diagnosed in 34 patients (28,3%),the III stage was diagnosed in 55 patients (45,8%), the IV stage was diagnosed in 31 patients (25,8%). These diagnostic and treatment were executed in accordance with currently clinical protocols. Measuring of indexes of external breathing function was conducted on the spirometer MS - 22. Analysis of results of studying of maintenance of ВNP for the patients with COPD depending on the degree of airflow limitation showed reliable (р≤0,05) differences of its level depending on disease severity. So, for 19 patients with forced expiratory volume (FEV)1≥61,0 % the level of ВNP was revealed for certain(р<0,001) as lower than among 15 patients with the level of FEV1= (60÷51) accordingly(73,6±7,1) pg/сm3 and(144,1±53,0) pg/сm3. On the whole 34 patients with COPD-ІІ had the level of ВNP (81,8±7,1) pg/сm3 and for certain it differed from the middle level of ВNP of 55 patients with COPD- ІІІ (231,6±29,6) pg/сm3, р≤0,001. By results of researches of 31 patients with FEV1≤30,0% it was revealed for certain that patients with FEV1= (30÷21) had higher level of ВNP than patients with FEV1≤21,0% (accordingly (483,2±43,6) pg/сm3 and (323,1±80,9) pg/сm3, р≤0,001). On the whole depending on severity of COPD the level of ВNP differed for certain. Studying of levels of ВNP depending on the amount of exacerbations of COPD for the last 12 months revealed that level of ВN for patients with COPD- ІІ for certain (р≤0,05) depended on the amount of exacerbations. So, at the single exacerbation it made (76,9±6,5) pg/сm3, and at three exacerbations it made 100,3±12,5 pg/сm3; thus indexes of level of ВNP for patients with two exacerbations were characterized by intermediate values. For patients with COPD- ІІІ the level of ВNP also for certain (р≤0,05) depended on the amount of exacerbations : at the double exacerbations it made(120,9±6,3) pg/сm3, and at three exacerbations it made 255,4±41,3 pg/сm3; thus indexes of level of ВNP for patients with many exacerbations were stable. For patients with COPD- ІV the level of ВNP did not depend on the amount of exacerbations and was stably high. On the whole, independently of the stage of COPD, received data testified to the continuous height of level of ВNP depending on the amount of exacerbations of disease . And, if at a 1-2 multiple exacerbation of COPD the level of ВNP was characterized by the values(76,08±6,5) of pg/сm3 and (96,92±11,1) pg/сm3, then at more amount of exacerbations was its reliable(р≤0,001) increase in 3-4 times (at three exacerbations it increased to (291,2±27,3) pg/сm3, at four it increased to (257,8±26,1) pg/сm3. Thus, regularities of relations between the degree of airflow limitation and level of ВNP for patients with COPD were revealed, that allowed to explain also relation between intensity of obstruction and processes of myocardium remodeling, as the level of ВNP, in this case, could be examined as a pathogenetic interlink. For the reflection of dependence of the level of ВNP from the degree of airflow limitation and frequency of exacerbations of COPD were made graphic and analytical (polynomial) models, application of that in clinical practice allowed to determine the predictable / reference levels of ВNP. The prospects of further researches are connected with the studying of possible relations between clinical symptom load, indexes of quality of life and level of BNP, as an earlier marker of myocardium remodeling.
1. Воронков Л.Г. Хронічна серцева недостатність / Л.Г. Воронков // Настанова з кардіології / Під ред. В.М. Коваленка. – Київ: Mopioн, 2009. - С. 1232-1296.
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