血清NT-proBNP、肺血管通透性指数及APACHE Ⅱ评分在急性肺水肿中的诊断价值

Diagnostic value of serum NT-proBNP,pulmonary vascular permeability index and APACHE Ⅱscore in patients with acute pulmonary edema

目的:探讨血清氨基末端-B型脑钠肽(NT-proBNP)、肺血管通透性指数(PVPI)及急性生理与慢性健康评分(APACHEⅡ)在急性肺水肿(APE)中的诊断价值。方法:选择21例急性肺损伤患者(急性肺损伤组)和22例APE患者作为研究对象,根据肺水B线评分将APE患者分为轻度APE组(<15分)和中度APE组(15~30分)。用脉波指示剂连续心排血量(PiCCO)法测定PVPI,电化学发光法测定血清NT-proBNP水平,并进行APACHEⅡ评分。采用受试者工作特征(ROC)曲线分析NT-proBNP、PVPI及APACHEⅡ评分单独检测及三者联合检测对APE的诊断价值。结果:轻度APE组和中度APE组APACHEⅡ评分、血清NT-proBNP水平及PVPI均显著高于急性肺损伤组,且中度APE组上述指标高于轻度APE组(均P<0.05)。APACHEⅡ评分、NT-proBNP、PVPI单独诊断及三者联合诊断APE的ROC曲线下面积(AUC)分别为0.810、0.818、0.851和0.910。肺水B线评分、NT-proBNP、PVPI、APACHEⅡ评分两两之间均呈正相关关系(均P<0.05)。结论:NT-proBNP、PVPI及APACHEⅡ评分均可用于APE的诊断和鉴别,且三者联合诊断效果更佳。

Objective:To investigate the diagnostic value of serum NT-proBNP,pulmonary vascular permeability index(PVPI)and APACHEⅡ score in patients with acute pulmonary edema(APE).Methods:21 patients with acute lung injury and 22 patients with APE were enrolled.APE patients were divided into mild and moderate groups according to pulmonary ultrasound monitoring B line number.Pulse indicator continous cadiac output(PiCCO)was used to measure PVPI.The NT-proBNP level in serum was determined by electrochemiluminescence(ECLA),and APACHEⅡ score was evaluated.The diagnostic values of NT-proBNP,PVPI and APACHEⅡ score for APE was analyzed.Results:The APACHEⅡ score,NT-proBNP,and PVPI in mild and moderate groups were higher than those in acute lung injury group,and these indexes were significantly higher in moderate group(P<0.05).The area under the ROC curve of APACHEⅡ score,NT-proBNP,PVPI and the combined detection were 0.810,0.818,0.851 and 0.910,respectively.There were positive correlations between the pulmonary ultrasound monitoring B line,APACHEⅡ score,NT-proBNP,and PVPI(P<0.05).Conclu sion:NT-proBNP,PVPI and APACHEⅡ score were valuable for the diagnosis of APE,and the combination of the three indexes could achieve better diagnostic effect.