老年心力衰竭患者肺部感染检验指标水平变化的研究

Level changes of test indexes of pulmonary infections in elderly patients with heart failure

目的探讨老年心力衰竭患者肺部感染降钙素原(PCT)、B型利钠肽(BNP)、氨基末端B型利钠肽前体/B型利钠肽(NT-proBNP/BNP)水平变化,为临床老年心力衰竭合并肺部感染诊断与治疗提供依据。方法选择2012年1月-2015年2月医院收治的256例心力衰竭住院患者为研究对象,按是否发生肺部感染分为感染组120例与非感染组136例,电化学发光全自动免疫分析仪检测PCT、NT-proBNP水平,放射免疫法检测BNP水平,分析检测结果在不同组间的表达差异。结果感染组患者PCT、NT-proBNP及NT-proBNP/BNP水平均显著高于非感染组患者,差异有统计学意义(P<0.05),两组患者BNP水平比较,差异无统计学意义;随心功能分级增加,PCT、BNP、NT-proBNP水平升高,差异有统计学意义(P<0.05),NT-proBNP/BNP差异无统计学意义;感染组患者PCT与NT-proBNP/BNP呈正相关(r=0.621,P<0.05),PCT与BNP、NT-proBNP均无显著相关性;120例感染组患者痰液标本共检出132株病原菌,其中革兰阴性菌、革兰阳性菌、真菌分别占68.18%、28.03%、3.79%。结论老年心力衰竭合并肺部感染患者PCT、BNP、NT-proBNP及NT-proBNP/BNP水平升高,NT-proBNP/BNP不受心功能影响,可反映感染程度。

OBJECTIVE To explore the changes in levels of PCT,BNP,NT-proBNP/BNP in elderly patients with heart failure complicated by pulmonary infections,so as to provide basis for clinical diagnosis and treatment of pulmonary infections in elderly patients with heart failure.METHODS A total of 256 elderly patients with heart failure in our hospital from Jan.2012 to Feb.2015 were selected.They were divided into the infected group（n =120）and the non-infected group（n = 136）according to the occurrence of pulmonary infections.PCT and NTproBNP levels were detected by ECL automated immunoassay analyzer,and the BNP level was detected by radioimmunoassay.The PCT,BNP,NT-proBNP/BNP levels were compared between different groups.RESULTS Compared with the non-infected group,PCT,NT-proBNP and NT-proBNP/BNP in the infection group were significantly higher（P〈0.05）,however,the difference in BNP levels was not significant.PCT,BNP and NTproBNP levels increased accordingly with higher heart function classification,the difference was significant（P〈0.05）.NT-proBNP/BNP showed no significant difference.PCT and NT-proBNP/BNP was positively correlated（r = 0.621,P〈0.05）while PCT had no significant correlation with BNP or NT-proBNP in the infected patients.Totally 132 pathogens were detected in sputum samples from patients,including gram-negative bacteria,gram-positive bacteria and fungi,accounting for 68.18%,28.03% and 3.79%.CONCLUSION The results show that PCT,BNP,NT-proBNP and NT-proBNP/BNP levels increase in elderly patients with heart failure complicated by pulmonary infections.NT-proBNP/BNP is not affected by cardiac function and it may reflect the degree of the infections.