Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Prognostic Role of B-type Natriuretic Peptide in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

만성폐쇄성폐질환의 급성 악화시 예후 인자로서의 혈중 B-type Natriuretic Peptide의 역할

  • Lee, Ji Hyun (Department of Internal Medicine, College of Medicine, Pochon CHA University) ;
  • Oh, So Yeon (Department of Internal Medicine, College of Medicine, Pochon CHA University) ;
  • Hwang, Iljun (Department of Internal Medicine, College of Medicine, Pochon CHA University) ;
  • Kim, Okjun (Department of Emergency Medicine, College of Medicine, Pochon CHA University) ;
  • Kim, Hyun Kuk (Department of Internal Medicine, College of Medicine, Pochon CHA University) ;
  • Kim, Eun Kyung (Department of Internal Medicine, College of Medicine, Pochon CHA University) ;
  • Lee, Ji-Hyun (Department of Internal Medicine, College of Medicine, Pochon CHA University)
  • 이지현 (포천중문 의과대학교 내과학교실) ;
  • 황일준 (포천중문 의과대학교 내과학교실) ;
  • 오소연 (포천중문 의과대학교 내과학교실) ;
  • 김옥준 (포천중문 의과대학교 응급의학과교실) ;
  • 김현국 (포천중문 의과대학교 내과학교실) ;
  • 김은경 (포천중문 의과대학교 내과학교실) ;
  • 이지현 (포천중문 의과대학교 내과학교실)
  • Published : 20040000
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Abstract

Background : The plasma B-type natriuretic peptide(BNP) concentration increases with the degree of pulmonary hypertension in patients with chronic respiratory disease. The aim of this study was to examine the prognostic role of BNP in the acute exacerbation of chronic obstructive lung disease (COPD). Method : We selected 67 patients who were admitted our hospital because of an acute exacerbation of COPD. Their BNP levels were checked on admission at the Emergency Department. Their medical records were analyzed retrospectively. The patients were divided into two groups according to their in-hospital mortality. The patients' medical history, comobidity, exacerbation type, blood gas analysis, pulmonary function, APACHE II severity score and plasma BNP level were compared. Results : Multiple logistic regression analysis identified three independent predictors of mortality: $FEV_1$, APACHE II score and plasma BNP level. The decedents group showed a lower $FEV_1$($28{\pm}7$ vs. $37{\pm}15%$, p=0.005), a higher APACHE II score($22.4{\pm}6.1$ vs. $15.8{\pm}4.7$, p=0.000) and a higher BNP level ($201{\pm}116$ vs. $77{\pm}80pg/mL$, p=0.000) than the sSurvivors group. When the BNP cut-off level was set to 88pg/mL using the receiver operating characteristic curve, the sensitivity was 90% and the specificity was 75% in differentiating between the survivors and decedents. On Fisher's exact test, the odds ratio for mortality was 21.2 (95% CI 2.49 to 180.4) in the patients with a BNP level > 88pg/mL. Conclusion : The plasma BNP level might be a predictor of mortality in an acute exacerbation of COPD as well as the $FEV_1$ and APACHE II score.

연구배경 : 혈중 BNP 의 측정은 간단한 혈액검사로 바로 시행할 수 있고 우심부하의 정도에 비례하여 증가하므로, 혈액 검사 당시의 혈역학적 상태를 잘 반영할 수 있다. 이에 저자들은 급성 악화로 응급실에 내원한 만성폐쇄성폐질환 환자의 혈역학적 불안정 정도가 환자의 예후와 상관이 있을 것으로 생각하였고, 이를 반영하는 지표로 혈중 BNP 검사를 이용하였다. 대상 및 방법 : 2002년 6월부터 2003년 12월까지 본원 응급실을 통해 만성폐쇄성폐질환의 급성악화로 입원한 환자 중 응급실 내원 당시 혈중 BNP 검사를 시행 받았던 환자를 대상으로 하여 입원 중이나 퇴원 후 24시간 이내에 사망한 환자와 생존한 환자를 두군으로 나누고 후향적으로 비교하였다. 결 과 : 다중회귀분석상 생존군과 사망군간에는 $FEV_1$(% of predicted), APACHE II score, BNP 수치만이 의미 있는 차이를 보였다(p=0.043, 0.025, 0.024). ROC curve 상 BNP 88pg/mL 이상에서 사망을 예측하는 민감도는 90%, 특이도는 75%를 보였고, BNP 88pg/mL를 기준으로 사망에 대한 Fisher's exact test를 시행하였을 때 교차비는 21.2였다. 결 론 : 본 연구 결과 혈중 BNP 값은 만성폐쇄성폐질환의 급성 악화 시에 예후를 예측할 수 있는 인자일 가능성이 있으며, 내원 당시 BNP 값이 높은 환자들에 대한 적극적인 처치가 필요할 것으로 사료되었다.

Keywords

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