前体脑钠肽升高在合并急性肾损伤的重症监护室患者中的临床价值

Clinical value of increased N-terminal pro-brain natriuretic peptide in ICU patients complicated with acute kidney injury

目的:探讨前体脑钠肽升高在合并急性肾损伤的重症监护室患者中的临床意义。方法:选取本院重症监护室患者178例进行研究。用RIFLE标准诊断AKI,分析NT-proBNP和AKI分级、心功能水平、病情危重程度和住院死亡率之间的关系。结果:单纯急性心力衰竭(AHF)患者NT-proBNP水平和左室射血分数及心衰临床分级相关。但是对于非单纯AHF的患者及所有重症监护室患者,NT-proBNP水平和左室射血分数无关。在这178例重症监护室患者中,NT-proBNP水平和APACHE-Ⅱ评分相关。经是否合并糖尿病、是否合并AKI、血红蛋白水平和APACHE-Ⅱ评分进行校正后,NT-proBNP升高和极危重症发展及院内死亡的风险增加相关。结论:对于合并AKI的重症监护室患者,肾功能不全会干扰NT-proBNP诊断AHF的临床价值,但是NT-proBNP升高是病情危重和院内死亡的独立危险因素,是病情危重和死亡的标志物。

Objective：To investigate the clinical significance of N-terminal pro-brain natriuretic peptide in the Intensive Care Unit （ICU） patients complicated with acute kidney injury （AKI）.Methods：A total of 178 patients hospitalized in the ICU of our hospital were included in the study.The correlations between NT-proBNP and AKI degree, cardiac function level, disease severity and in-hospital mortality were diagnosed by RIFLE criteria. In 178 ICU patients, NT-proBNP level was correlated with APACHE-II score. After adjusting the complicated diabetes, complicated AKI, hemoglobin level and APACHE-II score, the increased NT-proBNP was correlated with the increased risk of acute critical disease development and in-hospital death. Results：The level of NT-proBNP was correlated with left ventricular ejection fraction and clinical degree of heart failure in patients with acute heart failure （AHF）.However, in non-simple AHF patients and all ICU patients, NT-proBNP level was not correlated with left ventricular ejection fraction. Conclusion：In ICU patients complicated with AKI, renal insufficiency can interfere with the clinical value of NT-proBNP in the diagnosis of AHF.However, increased NT- proBNP is an independent risk factor for critical disease and in-hospital death, which is a marker of critical disease and death.