BNP在重症肺炎患者临床风险和预后估计中的意义

Role of B-type Brain Natriuretic Peptide in Clinical Condition and Diagnosis of Patients with Severe Pneumonia

目的探讨重症肺炎患者血浆B型钠尿肽(BNP)水平与疾病严重程度和预后的关系,为重症肺炎患者的临床风险和预后评估提供依据。方法测定重症肺炎患者入院时血BNP、超敏C反应蛋白(hs-CRP)水平,记录急性生理和慢性健康状况评分(APACHEⅡ),比较其在存活、死亡患者的差异;分析重症肺炎患者血BNP与APACHEⅡ、血hs-CRP、氧分压(PO_2)的相关性;分别绘制BNP、APACHEⅡ受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。结果本组重症肺炎患者68例,存活41例,死亡17例,死亡率39.71%;生存组患者血BNP、hs-CRP和APACHEⅡ较死亡组明显降低[BNP:216.00ng/L(26,936)比482.00ng/L(31,1156),P<0.01);hs-CRP:(93.10±36.73)mg/L比(117.00±39.29)mg/L,P<0.05;APACHEⅡ:(19.76±6.21)分比(25.15±7.36)分,P<0.01];生存组血PO_2较死亡组明显升高[(75.10±13.56)mm Hg比(56.11±8.02)mm Hg,P<0.01];重症肺炎患者血BNP水平与hs-CRP、APACHEⅡ呈正相关性(r=0.509,r=0.665),与PO_2呈负相关(r=-0.530);BNP预测死亡的AUC为0.745。结论 BNP可作为重症肺炎患者临床风险、预后的评估指标。

Objective To study the value of plasam B-type brain natriuretic peptide(BNP)in evaluating the condition and prognosis of patients with severe pneumonia.Methods The plasma BNP and hs-CRP level in patients with severe pneumonia were measured when they were admitted to the hospital,the scores of APACHEⅡwere evaluated,then the differences in these index between the survivor group and non-survivor group were compared.The correlation between BNP and APACHEⅡ,hs-CRP,PO2in patients with severe pneumonia was analyzed,the ROC curve was constructed.Results Of68patients with severe pneumonia,41survived and17died,with a mortality rate of39.71%.The level of plasma BNP[216.00ng/L(26,936)],hs-CRP(93.10±36.73mg/L),and APACHEⅡ(19.76±6.21)of the survivor group were significantly lower than those of the non-survivor group[482.00ng/L(31,1156),117.00±39.29mg/L,25.15±7.36,all P<0.01],and the PO2was higher(75.10±13.56mmHg vs56.11±8.02mmHg,P<0.01).The level of BNP was correlated to hs-CRP,APACHEⅡ(r=0.509,r=0.665),but negtively related to PO2(r=-0.530).The level of BNP at baseline generated an area under ROC curve of0.745.Conclusion Plasam BNP can be used to assess the condition and prognosis of patients with severe pneumonia.