B型钠尿肽对老年重症肺炎患者临床风险和预后的预测价值

黄勇; 赵丽; 苗利辉

doi:10.13201/j.issn.1009-5918.2021.05.002

B型钠尿肽对老年重症肺炎患者临床风险和预后的预测价值

- 首都医科大学附属复兴医院急诊科(北京, 100038)

详细信息

通讯作者: 苗利辉,E-mail:miaolihui1001@163.com

中图分类号: R563

收稿日期: 2021-02-24

Role of B-type natriuretic peptide in clinical condition and prognostic in elderly patients with severe pneumonia

- Department of Emergency, Fuxing Hospital, Capital Medical University, Beijing, 100038, China

More Information

Corresponding author: MIAO Lihui, E-mail: miaolihui1001@163.com

Received Date: 24 February 2021

摘要

摘要: 目的:探讨老年重症肺炎患者血浆B型钠尿肽(BNP)水平与疾病严重程度和预后的关系,为老年重症肺炎患者的临床风险和预后评估提供依据。方法:回顾性分析我科2018年1月-2019年6月期间61例≥60岁老年重症肺炎患者的资料。按预后分为死亡组(22例)和存活组(39例),比较两组患者入院后24 h内BNP、C-反应蛋白(CRP)、降钙素原(PCT)、APACHEⅡ评分,对BNP数值与APACHEⅡ评分进行相关性分析,分别绘制BNP值、APACHEⅡ评分的受试者工作特征曲线(ROC曲线)。结果:死亡组患者的入院24 h内BNP值、APACHEⅡ评分高于存活组患者(808.0±583.7 vs.158.3±54.5,29.3±4.4 vs.20.3±4.1,均P<0.01)。存活组和死亡组的入院24 h内BNP数值与APACHEⅡ评分(r=0.892、r=0.758)均呈正相关,且老年重症肺炎患者入院24 h内BNP水平、APACHEⅡ评分的ROC曲线下面积为0.980和0.927。结论:死亡组患者的入院24 h内BNP水平、APACHEⅡ评分高于存活组患者,BNP可作为老年重症肺炎患者临床风险、预后的评估指标。
- 老年重症肺炎 /
- B型钠尿肽 /
- APACHE Ⅱ评分 /
- C-反应蛋白 /
- 降钙素原 /
- 临床风险 /
- 预后
Abstract: Objective: To investigate the value of B-type natriuretic peptide(BNP) in evaluating the clinical condition and prognosis of elderly patients with severe pneumonia.Methods: Data of 61 cases of elderly paitents ≥60 years old with severe pneumonia admitted to Department of Emergency from January 2018 to June 2019 were retrospectively analyzed. They were divided into two groups: non-survivor group(n=22) and survivor group(n=39). Serum levels of BNP,CRP,PCT and APACHE Ⅱ score in 24 hours after admission were compared between two groups. Correlation between BNP value and APACHE Ⅱ score in 24 hours after admission were analyzed. The receiver-operating characteristic cure(ROC curve) was plotted at 24 hours to analyze the accuracy of BNP level and APACHE Ⅱ score.Results: The BNP values and APACHE Ⅱ score of non-survivor group were significantly higher than those of survivor group in 24 hours after admission(808.0±583.7 vs. 158.3±54.5, 29.3±4.4 vs. 20.3±4.1, both P<0.01). In both groups, BNP values and APACHE Ⅱ score showed a positive correlation(r=0.892,r=0.758), BNP ROC and APACHE Ⅱ score ROC had an area under curve(AUC) of 0.980 and 0.927 in 24 hours after admission.Conclusion: The BNP values and APACHE Ⅱ score of non-survivor group were significantly higher than those of survivor group in 24 hours after admission. BNP can be used to assess the clinical condition and prognosis of elderly patients with severe pneumonia.
- elderly patients with severe pneumonia /
- B-type natriuretic peptide /
- acute physiology and chronic health evaluation Ⅱ score /
- C-reactive protein /
- procalcitonin /
- clinical condition /
- prognosis

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参考文献(15)

[1]	Bahlis LF,Diogo LP,Kuchenbecker RS,et al.Clinical,epidemiological,and etiological profile of inpatients with community-acquired pneumonia in a pubilc hospital in the interior of Brazil[J].JBras Pneumol,2018,44(4):261-266.
[2]	Leoni D,Rello J.Severe community-acquired pneumonia:optimal management[J].Curr Opin Infect Dis,2017,30(2):240-247.
[3]	中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[4]	Goncalves MC,Horewicz VV,Lückemeyer DD,et al.Experimental Sepsis Severity Score Associated to Mortality and Bacterial Spreading is Related to Bacterial Load and Inflammatory Profile of Different Tissues[J].Inflammation,2017,40(5):1553-1565.
[5]	Motos A,Kidd JM,Nicolau DP.Optimizing Antibiotic Administration for Pneumonia[J].Clin Chest Med,2018,39(4):837-852.
[6]	Pandompatam G,Kashani K,Vallabhajosyula S.The role of natriuretic peptides in the management,outcomes and prognosis of sepsis and septic shock[J].Rev Bras Ter Intensiva,2019,31(3):368-378.
[7]	Kakoullis L,Giannopoulou E,Papachristodoulou E,et al.The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction:A systematic review[J].Int J Clin Pract,2019,73(7):e13374.
[8]	Christ-Crain M,Breidthardt T,Stolz D,et al.Use of B-typenatriuretic peptide in the risk stratification ofcommunity-acquiredpneumonia[J].JIntern Med,2008,264(2):166-176.
[9]	Usuda D,Sangen R,Hashimoto Y,et al.Validation of a B-type natriuretic peptide as a prognostic marker in pneumonia patients:a prospective cohort study[J].BMJ Open,2016,6(2):e010440.
[10]	Li J,Ye H,Zhao L.B-type natriuretic peptide in predicting the severity of community-acquired pneumonia[J].World J Emerg Med,2015,6(2):131-136.
[11]	Zu H,Li Q,Huang P,et al.Therapeutic value of blood purifcation and prognostic utilities of early serum procalcitonin,C reactive protein,and brain natriuretic peptide levels in severely burned patients with sepsis[J].Cell Biochem Biophys,2015,72(1):259-263.
[12]	Nowak A,Breidthardt T,Christ-Crain M,et al.Direct comparison of three natriuretic peptides for prediction of short-and long-term mortality in patients with community-acquired pneumonia[J].Chest,2012,141(4):974-982.
[13]	Zhang S,Zhang HX,Lin RY,et al.Predictive role of NT-pro BNP for adverse cardiac events in community-acquired pneumonia a retrospective study[J].Int J Clin Exp Med,2016,9(7):14411-14417.
[14]	莫新,梁艳冰,陈志斌,等.重症肺炎患者血清胆碱酯酶含量变化及其与急性病生理学和长期健康Ⅱ评分、多器官功能障碍综合征评分的相关性研究[J].中华危重症医学杂志(电子版),2016,9(3):159-162.
[15]	Akpinar EE,Hosgun D,Akpinar S,et al.Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneuonia?[J].J Bras Pneumol,2019,45(4):e20180417.