B型钠尿肽在新型冠状病毒肺炎临床分型评估中的价值

Value of B-type natriuretic peptide in evaluating the clinical classification of coronavirus disease 19

目的探讨B型钠尿肽(BNP)在新型冠状病毒肺炎(COVID-19)临床分型中的意义。方法选取2020年2月10日至3月29日武汉某新型冠状病毒肺炎专科医院COVID-19确诊患者335例。根据国家卫生健康委员会发布的《新型冠状病毒感染的肺炎诊疗方案(试行第七版)》中的临床分型方案,将患者分为轻型、普通型、重型、危重型4组。用化学发光法检测患者血浆BNP及血清白介素-6(IL-6)水平,并对各组患者性别、年龄、BNP及IL-6检测结果进行分析比较。结果研究纳入COVID-19患者335例,其中轻型6例,普通型207例,重型111例,危重型患者11例。COVID-19重型患者血浆BNP水平为22.5(0.01,72.3) pg/m L,显著高于普通型患者(P<0.01),其余各组间差异无统计学意义。不同临床分型患者BNP水平大于100 pg/m L的比例分别为:普通型4.3%(9例)、重型20.7%(23例)、危重型54.4%(6例),轻型患者BNP均在正常范围内,该比例在不同分型间差异有统计学意义(χ^2=40.8,P<0.01)。335例中有198例同时检测IL-6水平,其结果与对应BNP水平作相关性分析,二者呈正相关(rs=0.203,P<0.01)。结论血浆BNP水平与COVID-19患者病情严重程度密切相关,并且BNP与炎症因子IL-6水平呈正相关,联合二者可更好地对COVID-19患者进行临床分型。

Objective To investigate the value of B-type natriuretic peptide( BNP) in evaluating the clinical classification of coronavirus disease 19( COVID-19). Methods A total of 335 COVID-19 patients confirmed in the specialized hospital of COVID-19 in Wuhan during February 10,2020 and March 29,2020 were enrolled in our study. According to the Diagnosis and Treatment Protocol of Novel Coronavirus Pneumonia( Trial Version 7) issued by the National Health Commission of the People’s Republic of China,the patients were divided into four types: mild,common,severe and critical. The levels of plasma BNP and serum interleukin-6( IL-6) were detected by the chemiluminescence method. The differences of gender,age,BNP and IL-6 in different types were analyzed. Results Among 335 COVID-19 patients,6 were diagnosed as mild type,207 as common,111 as severe and 11 as critical. Plasma BNP levels in the patients with severe COVID-19 were 22.5( 0.01,72.3) pg/m L,which was significantly higher than that with common COVID-19( P<0.01). There was no significant difference between the other groups. The proportions of the patients with BNP level higher than 100 pg/m L in common,severe and critical types were 4.3%( n = 9),20.7%( n = 23) and 54.4%( n = 6),respectively. The BNP levels of the patients with mild COVID-19 were within the normal range. There was significantly statistical difference in the proportions of different types( χ^2= 40.8,P<0.01). Serum IL-6 levels were detected in 198 of 335 patients,and the correlation analysis showed that serum IL-6 levels were positively correlated with plasma BNP levels( rs= 0. 203,P < 0. 01). Conclusion Plasma BNP levels are closely related to the severity of COVID-19 patients. In addition,plasma BNP levels are positively correlated with serum IL-6 levels,and their combination can better distinguish the clinical types of COVID-19 patients.