急性呼吸窘迫综合征患者NT-proBNP与病情严重程度及预后的关系

Relationship between NT-pro BNP and the severity and prognosis of acute respiratory distress syndrome

目的探讨急性呼吸窘迫综合征(ARDS)患者氨基末端B型脑钠肽(NT-pro BNP)与病情严重程度及预后的关系。方法选择87例ARDS患者,在积极治疗的同时,根据柏林标准病情严重程度分层分为轻度组、中度组和重度组,根据住院期间预后分为存活组和死亡组,分析不同严重程度及预后相关因素、NT-pro BNP与不同病情严重程度和住院期间预后的关系。结果不同严重程度患者APACHEⅡ、Murray、NT-pro BNP、肌酐、尿素氮、空腹血糖、p H值差异均有统计学意义(P<0.05)。APACHEⅡ、Murray、NT-pro BNP与ARDS严重程度呈正相关(r=0.595、0.545、0.563,P<0.05)。APACHEⅡ、Murray分别与NT-pro BNP呈正相关(r=0.584、0.544,P<0.05)。存活组与死亡组年龄、APACHEⅡ、Murray、NT-pro BNP、肌酐、尿素氮、空腹血糖、p H值、氧合指数、肺外器官衰竭数目差异均有统计学意义(P<0.05)。APACHEⅡ、Murray、NT-pro BNP、肺外器官衰竭数目是ARDS近期预后独立危险因素,氧合指数是保护因素(P<0.05)。NT-pro BNP对ARDS预后判断的ROC曲线下面积为0.798,截点为333.92 pg/m L,灵敏度为81.92%,特异度为91.89%,约登指数为0.732。结论血浆NT-pro BNP有助于早期判断ARDS严重程度及住院期间预后,可作为临床预测标志物。

Objective To investigate the acute respiratory distress syndrome （ARDS） in patients with amino-terminal pro-B-type relationship of brain natriuretic peptide （NT-proBNP） and the severity and prognosis. Methods A total of 87 cases of ARDS patients in active treatment at the same time, according to the severity of Berlin standards groups stratified into mild, moderate and severe groups, divided according to the prognosis of survival group and death group during hospitalization, relationship of different severity and prognostic factors, NT-proBNP with different severity and prognosis during hospitalization were analyzed. Results The severity of the patient APACHEII, Murray, NT-proBNP, creatinine, blood urea nitrogen, fasting glucose, pH value of the differences were statistically significant （P〈0.05）. APACHEII, Murray, NT-proBNP and severity of ARDS were positively correlated （r=0.595, 0.545, 0.563, P〈0.05）. APACHEII, Murray was positively correlated with NT-proBNP（r=0.584, 0.544, P〈0.05）. The differences of age, APACHEII, Murray, NT-proBNP, creatinine, blood urea nitrogen, fasting blood glucose, pH value, oxygenation index, number of extrapul-monary organ failure of survival and nonsurvivors groups were statistically significant （P〈0.05）. APACHEII, Murray, NT-proBNP, the number of extrapulmonary organ failure were independent risk factor for prognosis ARDS, oxygenation index was a protective factor （P〈0.05）. The area under the ROC curve for NT-proBNP for prognosis ARDS was 0.798, cut-off point for 333.92 pg/mL, the sensitivity of 81.92% and the specifici ty was 91.89%, Youden index was 0.732. Conclusion Plasma NT-proBNP helps early prognosis of ARDS severity and duration of hospitalization, can be used as markers of clinical predictors.