老年危重症患者BNP水平与APACHE Ⅱ评分的相关性及与预后的关系

Correlation between serum B-type natriuretic peptide and acute physiology and chronic health evaluation Ⅱ score and prognosis of elderly severe patients

目的探讨老年危重症患者的脑钠肽（BNP）水平与急性生理学与慢性健康状况Ⅱ评分（APACHEⅡ）的相关性及与预后的关系。方法选取128例老年危重症患者,检测30 min内静脉血浆BNP,计算24 h内的APACHEⅡ分值。根据APACHEⅡ分值将患者分为高危组（〉20分）、中危组（10~20分）和低危组（〈10分）,比较3组间BNP水平的差异。结果 BNP水平在高危组（567.02 pg/ml）明显高于中危组（385.79 pg/ml）和低危组（30.30 pg/ml）（P〈0.01）,且和APACHEⅡ评分呈显著正相关（r=0.489,P=0.028）;根据28 d生存情况将患者分为存活组与死亡组,存活组患者BNP水平（211.93 pg/ml）及APACHEⅡ评分（21.05±7.80）均明显低于死亡组的BNP水平（697.40 pg/ml）及APACHEⅡ评分（28.19±11.17）（P〈0.05）;多因素Logistic回归分析提示BNP水平为28 d死亡的危险因素（P=0.034）。结论老年危重症患者BNP水平与APACHEⅡ评分及病死率呈正相关,可作为评价病情危重程度及预后的指标。

Objective To explore the relationship between B-type natriuretic peptide（BNP） and acute physiology and chronic health evaluation Ⅱscore（APACHE Ⅱscore） in elderly severe patients,and to investigate the relationship of BNP with prognosis. Methods 128 elderly patients in ICU were enrolled in this study. The plasma level of BNP was detected in 30 min,and APACHE Ⅱscore was calculated in 24 h. The patients were divided into high risk group（ 20）,medium risk group（10-20） and low risk group（ 10） according to APACHEⅡ score. Results The BNP level in the high risk group（567. 02 pg /ml） was significantly higher than that of the other two groups（P〈 0. 01）; and the BNP level was positively correlated with APACHE II score（ r = 0. 489,P = 0. 028）. All the patients were divided into the survival group and the dead group according to the 28 th day＇s survival situation. The level of BNP（211. 93 pg /ml） and APACHEⅡscore（21. 05 ± 7. 80） in the survival group were significantly lower than those in the dead group（P〈0. 05）. Multivariate Logistic regression analysis showed that BNP level was a risk factor for mortality（ P = 0. 034）. Conclusions The level of BNP is positively correlated with APACHE Ⅱ score and mortality rate,which can be used to evaluate the severity and prognosis of the elderly patients in ICU.