N末端脑钠肽前体对非心源性危重患者预后判断的应用

Prognostic value of N-terminal pro-brain natriurelic peptide in intensive non-cardiogenic patients

目的评价血浆N末端脑钠肽前体(N-terminal pro-brain natriurelic peptide,NT-proBNP)对非心源性危重患者预后评估的价值。方法选择2009年12月至2010年11月在常德市第一人民医院重症监护病房(intensive care unit,ICU)住院的128例非心源性疾病成年患者为研究对象,在其入ICU的24 h内检测血浆NT-proBNP浓度,计算其急性生理学及慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ),记录随访患者入ICU后28 d内的生存状况,并根据以上数据绘制受试者工作特征(ROC)曲线,分析血浆NT-proBNP浓度与28 d病死率的关系。结果 128例患者中,88例存活,40例死亡。死亡组血浆NT-proBNP浓度[6 656(310～35 000)ng/L vs.1 213(17～33 061)ng/L,P<0.05]及APACHEⅡ评分[21(13～53)分vs.18(5～38)分,P<0.05]高于存活组,差异有统计学意义。血浆NT-proBNP浓度预测患者入ICU后28 d内死亡的曲线下面积比APACHEⅡ评分高,差异有统计学意义(0.804±0.039 vs.0.673±0.048,P<0.05);血浆NT-proBNP浓度>1 984 ng/L时预测患者28 d内死亡的敏感性为87.5%,特异性为62.5%。结论血浆NT-proBNP浓度对非心源性危重患者的预后具有较好的预测价值,超过1 984 ng/L者预后不良。

Objectives To evaluate the predictive effect of serum N-terminal pro-brain natriurelic peptide （NT-proBNP） for prognosis in critically ill non-cardiogenic patients. Methods One hundred and twenty eight patients admitted to intensive care unit （ICU）were selected in The First People＇s Hospital of Changde from Dec. 2009 to Nov. 2010. Serum NT-proBNP was measured and an acute physiology and chronic health evaluation II （APACHE II ）score was calculated in 24 hours when the patients were admitted to ICU.After 28 days, the vital status of each patient was ascertained.The receiver operating characteristic （ROC）curves were constructed according to data of serum concentration of NT-proBNP and 28-day mortality, and the predictive effect of serum NT-proBNP for prognosis was analyzed. Results A total of 128 non-cardiogenic patients treated in ICU were enrolled, among which 88 cases survived and other 40 cases died within 28 days. There was significant difference both in serum NT-proBNP and in APACHE 1[ score between the survivor group and the non-survivor group [6 656（316-35000）ng/L vs. 1 213（17-33 061 ）ng/L,P〈0.05 ; 21 （13-53）分 vs. 18（5-38） 分）, P〈0.05 ]. The area under ROC of NT-proBNP was higher than that of APACHE II score E （0.804±0.039） vs. （0.673 ± 0.048）, P〈0.05 ）1. The sensitivity and specificity of predicting 28-day mortality with secrum concentration of NT-proBNP more than 1 984 ng/L was 87.5 % and 62.5%. Conclusions High serum concentration of NT-proBNP can predict mortality in critically ill non-cardiogenic patients. The patients with NT-proBNP more than 1 984 ng/L may have bad prognosis.