[Effect of nasal intermittent positive pressure ventilation on N-terminal pro-brain natriuretic peptide in patients with acute exacerbations of chronic obstructive pulmonary disease and type II respiratory failure].

OBJECTIVE: To investigate the effect of nasal intermittent positive pressure ventilation (NIPPV) on N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure.

METHODS: Forty patients with AECOPD and type II respiratory failure and 40 patients with stable phase chronic obstructive pulmonary disease were randomly assigned into study. Plasma levels of NT-proBNP, arterial blood gas, APACHE II scores, and pulmonary artery pressures were measured. The plasma level of NT-proBNP was compared between the two groups. Effect of NIPPV on NT-proBNP was studied in patients with AECOPD and type II respiratory failure.

RESULTS: There were negative correlations between NT-proBNP and pH, and between NT-proBNP and PaO2 (r=-0.691,r=-0.704,respectively;P<0.001),positive correlations between NT-proBNP and PaCO2, and between NT-proBNP and APACHE II scores (r=0.774, r=0.810, respectively, P< 0.001), and positive correlation between NT-proBNP and PAP (r=0.965, P<0.001) in all patients. In patients with AECOPD and type II respiratory failure, there were negative correlations between NT-proBNP and pH,and between NT-proBNP and PaO2 (r=-0.636, r=-0.616,respectively; P<0.001); there were positive correlations between NT-proBNP and PaCO2, and between NTproBNP and APACHE II scores (r=0.545, r=0.475, respectively; P=0.001, P=0.002); and there were positive correlation between NT-proBNP and pulmonary artery pressure (r=0.833,P<0.001). The plasma levels of NT-proBNP were significantly higher in patients with AECOPD and type II respiratory failure than in control subjects [(939.60 ± 250.00) pg/mL vs (151.55 ± 111.20) pg/mL;P<0.01]. NIPPV decreased plasma levels of NT-proBNP [(229.15 ± 98.26) pg/mL vs (939.60 ± 250.00) pg/mL; P<0.01] in patients with AECOPD and type II respiratory failure, as well as improved arterial blood gas and APACHE II scores. Although NIPPV appeared to decrease pulmonary artery pressure somewhat between pre-treatment and post-treatment groups, the differences were not statistically significant (P=0.056).

CONCLUSION: The plasma level of NT-proBNP reflects the severity of patients with AECOPD and type II respiratory failure. NIPPV can decrease a patient's splasma level of NT-proBNP, which has clinical value for evaluating the effect of NIPPV.