降钙素原、C反应蛋白、氨基末端脑钠肽前体预测老年肺炎患者发生房颤的价值

Prediction of atrial fibrillation occurrence in pneumonia geriatrics with procalcitonin,Creactive protein and NT-pro BNP

目的比较降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、氨基末端脑钠肽前体(N-terminal pro-brainnatriuretic peptide,NT-proBNP)对老年人社区获得性肺炎(community acquired pneumonia,CAP)患者房颤发病率的预测价值,为临床门(急)诊接诊老年人感染患者提供参考和预警。方法选择2009-02至2013-02在解放军总医院住院的CAP老年患者(CAP组)和非感染的老年患者(对照组)纳入研究。在门(急)诊或当天入院时完成心电图、心脏超声、抽血化验检查,排除二尖瓣狭窄等患者。记录患者自入院后3个月、1年内房颤发病率和房颤类型。分别计算PCT、CRP、NT-proBNP初诊值和入院后3个月内最高观测值对房颤的预测值。结果共入组156例,CAP组120例,对照组36例。CAP组PCT、CRP、NT-proBNP均较对照组升高(P <0. 05);CAP组入院后3个月内及1年内房颤发病率均高于对照组(P <0. 05)。PCT阳性预测能力最高,CRP最高观测值的阴性预测能力最高。结论在老年人(CAP)感染患者门(急)诊就诊时或住院早期,PCT不失为预测房颤发病率的较好选择。病程中CRP持续阴性预示着更低的房颤发病率。

Objective To compare the ability of procalcitonin,C-reactive protein( CRP) and N-terminal pro-B-type natriuretic peptide( NT-pro BNP) to predict the occurrence of atrial fibrillation in geriatric community acquired pneumonia( CAP) patients.Methods Geriatric patients with CAP or without infections were enrolled in this study and divided into two groups: CAP group and control group( non-infection group),while patients with mitral stenosis and other diseases were excluded. These patients were examined with electrocardiograms and cardiac ultrasound and had their blood detected quickly. The incidence and types of atrial fibrillation were observed. The ability of the initial values and peak values three months after hospitalization of PCT、CRP and NT-proBNP to predict atrial fibrillation was calculated. Results A total of 156 male patients were enrolled,including 120 patients with CAP and 36 patients as control. Morbidity was higher in the CAP group. PCT had the highest positive predictive value for the occurrence of atrial fibrillation,while the initial diagnostic value of PCT and peak value of CRP after three months displayed the highest negative predictive value. Conclusions PCT may be a promising option to predict the chance of atrial fibrillation among geriatric patients of CAP in the early stage. Persistent negative values of CRP indicate less chance of atrial fibrillation.