老年重症社区获得性肺炎入住ICU患者血清B型钠尿肽、降钙素原、C反应蛋白变化特点及临床意义

Change characteristics and clinical significance of serum B-type natriuretic peptide,procalcitonin and C-reactive protein in elderly patients with severe community-acquired pneumonia admitted to ICU

目的分析老年重症社区获得性肺炎(CAP)入住ICU(重症监护室)患者血清B型钠尿肽(BNP)、降钙素原(PCT)、C反应蛋白(CRP)水平变化特点,探讨其临床意义。方法选取2017年6月~2019年6月我院收治入住ICU的老年重症CAP患者100例作为观察组,包括生存50例和死亡50例;选取同期未入住ICU的老年重症CAP患者100例作为对照组。检测两组患者入院时血清BNP、PCT、CRP水平及观察组入住ICU第1天和第5天血清BNP、PCT、CRP水平,比较其动态变化。结果入院时,观察组患者血清BNP(1622.34±10.93)pg/mL、PCT(50.54±11.43)ng/mL、CRP(81.34±10.01)ng/L明显高于对照组患者血清BNP(157.32±20.01)pg/mL、PCT(4.35±1.13)ng/mL、CRP(19.38±2.13)ng/L,观察组死亡患者血清BNP、PCT、CRP明显高于生存患者,死亡患者第5天血清BNP(1924.22±10.02)pg/mL、PCT(57.30±9.02)ng/mL、CRP(88.30±12.32)ng/L与第1天血清BNP(1891.20±56.59)pg/mL、PCT(61.20±8.92)ng/mL、CRP(90.03±19.22)ng/L比较,差异有统计学意义(P<0.05)。结论动态监测BNP、PCT、CRP水平指导临床诊治,有助于判断老年患者是否需要转入ICU强化治疗,值得临床推广使用。

Objective To analyze the change characteristics of serum B-type natriuretic peptide(BNP),procalcitonin(PCT)and C-reactive protein(CRP)levels in elderly patients with severe community-acquired pneumonia(CAP)admitted to intensive care unit(ICU)and explore the clinical significance.Methods 100 elderly patients with severe CAP admitted to ICU of our hospital from June 2017 to June 2019 were selected as the research subjects.They were divided into survival group(n=50)and death group(n=50).100 elderly patients with severe CAP who were not admitted to ICU during the same period were selected as the control group.The levels of serum BNP,PCT and CRP in the two groups of patients on the occasion of admission,and the dynamic changes of serum BNP,PCT and CRP in the survival group and the death group on the 1st and 5th day of admission to ICU were detected and compared.Results On the occasion of adminssion,serum BNP(1622.34±10.93)pg/mL,PCT(50.54±11.43)ng/mL,CRP(81.34±10.01)ng/L of the patients in the observation group were significantly higher than those in the control group[BNP(157.32±20.01)pg/mL,PCT(4.35±1.13)ng/mL,CRP(19.38±2.13)ng/L].The serum BNP,PCT and CRP of the patients in the death group of the observation group were significantly higher than those of the survival patients.The serum BNP(1924.22±10.02)pg/mL,PCT(57.30±9.02)ng/mL,CRP(88.30±12.32)ng/L of the patients in the death group on the 5th day were significantly different from the serum BNP(1891.20±56.59)pg/mL,PCT(61.20±8.92)ng/mL,CRP(90.03±19.22)ng/L on the 1st day,and the difference was statistically significant(P<0.05).Conclusion Tracing the dynamic changes of BNP,PCT and CRP levels is beneficial to judging whether elderly patients need intensive treatment in ICU and it helps guiding clinical diagnosis and treatment,so it is worthy of vigorous clinical promotion and application.