急性呼吸窘迫综合征患者血清PCT、NT-proBNP水平变化及意义

Changes and significance of serum PCT and NT⁃proBNP levels in patients with acute respiratory distress syndrome

目的探究急性呼吸窘迫综合征(ARDS)患者血清降钙素原(PCT)、N末端B型脑钠肽前体(NT⁃proBNP)变化及意义。方法选取本院2017年10月至2019年10月收治的96例ARDS患者,根据患者病情严重程度分为轻度组(n=39)、中度组(n=31)和重度组(n=26),并观测患者住院28d死亡情况,分为生存组(n=84)和死亡组(n=12),记录患者临床基线资料、血清因子等指标,对比各组差异,Spearman检验分析血清PCT、NT⁃proBNP与SOFA、APACHEⅡ的相关性;受试者工作特征曲线(ROC)及曲线下面积(AUC)分析血清PCT、NT⁃pro BNP在ARDS患者预后诊断中的价值。结果轻度组、中度组及重度组性别、年龄、呼吸频率、吸氧浓度、平均动脉压(MAP)、中心静脉压(CVP)、白细胞计数(WBC)、血红蛋白(Hb)、白蛋白(ALB)比较,差异无统计学意义(P>0.05)。轻度组、中度组及重度组RICU住院时间、机械通气时间、氧合指数(OI)、心率(HR)、PCT、NT⁃proBNP、SOFA及APACHEⅡ评分比较,差异具有统计学意义(P<0.05)。PCT与SOFA及APACHEⅡ评分存在明显正相关性,NT⁃proBNP与SOFA及APACHEⅡ评分存在明显负相关性,差异具有统计学意义(P<0.05)。存活组与死亡组血清PCT、NT⁃proBNP水平比较差异具有统计学意义(P<0.05)。ROC曲线结果显示,PCT、NT⁃proBNP及两者联合诊断的AUC分别为0.847(95%CI 0.795~0.900)、0.729(95%CI 0.657~0.802)、0.932(95%CI 0.899~0.965)。结论血清PCT、NT⁃pro BNP对于预测ARDS患者病情严重程度及预后具有显著价值,可作为ARDS早期诊断的参考指标。

Objective To investigate the changes and significance of serum procalcitonin(PCT)and N⁃terminal B⁃type natriuretic peptide precursor(NT⁃proBNP)in patients with acute respiratory distress syndrome(ARDS).Methods A total of 96 patients with ARDS treated in our hospital from October 2017 to October 2019 were selected and divided into mild group(n=39),moderate group(n=31),and severe group(n=26)according to the severity of their patients.),And observe the 28⁃day deaths of patients in the hospital.They were divided into survival group(n=84)and death group(n=12).Patients􀆳clinical baseline data,serum factors and other indicators were recorded.Differences between the groups were compared.Spearman test was used to analyze serum PCT,The correlation between NT⁃pro BNP and SOFA and APACHEⅡ;the receiver operating characteristic curve(ROC)and the area under the curve(AUC)analyzed the value of serum PCT and NT⁃pro BNP in the prognosis diagnosis of ARDS patients.Results Defferences in gender,age,respiratory rate,oxygen concentration,mean arterial pressure(MAP),central venous pressure(CVP),white blood cell count(WBC),hemoglobin(Hb),albumin(ALB)in mild,moderate and severe groups no statistical significance(P>0.05).There were statistically significant differences in hospitalization time,mechanical ventilation time,oxygenation index(OI),heart rate(HR),PCT,NT⁃pro BNP,SOFA,and APACHEⅡscores in the mild,moderate and severe groups(P<0.05).There was a significant positive correlation between PCT and SOFA and APACHEⅡscores,and a significant negative correlation between NT⁃pro BNP and SOFA and APACHEⅡscores(P<0.05).The differences in serum PCT and NT⁃pro BNP levels between the survival group and the death group were statistically significant(P<0.05).ROC curve results showed that the AUC of PCT,NT⁃pro BNP,and the combined diagnosis were 0.847(95%CI 0.795~0.900),0.729(95%CI 0.657~0.802),0.932(95%CI 0.899~0.965).Conclusion Serum PCT and NT⁃pro BNP have significant value in predicting the severity and prognosis of patients with ARDS,and can be used as reference indicators for early diagnosis of ARDS.