血浆氨基末端B型脑钠肽前体在急性呼吸窘迫综合征中应用价值的探讨

The application value of plasma NT - proBNP concentration in acute respiratory distress syndrome

目的 探讨血浆氨基末端B型脑钠肽前体（NT-proBNP）在急性呼吸窘迫综合征（ARDS）诊断、严重程度及预后评估中的应用价值.方法 比较50例ARDS患者（ARDS组）、50例急性心力衰竭患者（心力衰竭组）及50例健康体检者（对照组）血浆NT-proBNP水平的差异；监测ARDS存活组和死亡组在入选研究时、第24 h及第96 h血浆NT-proBNP水平,记录入选24h内Murray急性肺损伤评分和APACHEⅡ评分,分析各参数的变化及参数间的相关性；衡量NT-proBNP、Murray急性肺损伤评分和APACHEⅡ评分对ARDS患者预后评估的能力.结果 ①ARDS组血浆NT-proBNP水平高于对照组,明显低于心力衰竭组,差异均有统计学意义（P＜0.01）.②50例ARDS患者中死亡10例,存活40例；死亡组在入选本研究时,第24h和第96 h时血浆NT-proBNP水平、Murray急性肺损伤评分和APACHEⅡ评分均较存活组明显升高（P＜0.01）.③ARDS患者血浆NT-proBNP水平与Murray急性肺损伤评分、APACHEⅡ评分呈高度正相关（r =0.688,P＜0.01；r =0.812,P＜0.01）.④将NT-proBNP水平335 pg/mL作为截断点时,是预测死亡的最佳敏感度（80.0％）和特异度（92.5％）.NT-proBNP与Murray急性肺损伤评分、APACHEⅡ评分对ARDS预后评估价值差异无统计学意义（Z=1.12,P＞0.05；Z=1.713,P＞0.05）.结论 血浆NT-proBNP水平可成为ARDS患者诊断、严重程度及预后评估的重要生化标志物.

Objective To explore the diagnostic and prognostic value of plasma N - terminal B - type natriuretic peptide （ NT - proBNP） level in patients with acute respiratory distress syndrome （ARDS）. Methods Compare the difference of NT - proBNP level between ARDS group （50 patients）, heart failure group （50 patients） and control group （50 healthy patients） ; The NT- proBNP level, Murray acute lung injury score and APACHE Ⅱ score of the survival and death subgroup within the ARDS group were recorded on basal level and 24 hours and 96 hours after enrollment. The change of these parameters and their correlation were analyzed. The capability of prognosing ARDS of NT - proBNP, Murray acute lung injury score, and APACHE Ⅱ score was evaluated. Results ①Plasma NT - proBNP levels of ARDS Group （ 251.03 ± 31. 62 ） was higher than that of the control group （84.10 ± 14.26 ）, but was significantly lower than that of the heart failure group （7708.20 ± 2661.92）, the difference was statistically significant （P 〈 0.01 ）. ②Within the ARDS group, 10 patients was died and 40 patients was survived ; plasma NT - proBNP concentrations, Murray acute lung injury score, andAPACHE Ⅱ score of the death subgroup were significantly higher than those in the survival subgroup （P 〈0. 01 ）. ③Plasma NT- proBNP levels in ARDS group was positively correlated with both Murray acute lung injury score and APACHE Ⅱ score（ r = 0. 688, P 〈 0.01 ; r = 0. 812, P 〈 0. 01 ）. ④When the cutoff point of NT- proBNP concentration was 335 pg/mL, we got the best sensitivity（ 80% ）and best specificity（92.5% ）to predict death. Conclusion Plasma NT- proBNP may become an important biomarker for ARDS diagnosis as well as severity and prognosis evaluation.