B型钠尿肽对老年重症肺炎患者临床风险和预后的预测价值

Role of B-type natriuretic peptide in clinical condition and prognostic in elderly patients with severe pneumonia

目的:探讨老年重症肺炎患者血浆B型钠尿肽(BNP)水平与疾病严重程度和预后的关系,为老年重症肺炎患者的临床风险和预后评估提供依据。方法:回顾性分析我科2018年1月-2019年6月期间61例≥60岁老年重症肺炎患者的资料。按预后分为死亡组(22例)和存活组(39例),比较两组患者入院后24 h内BNP、C-反应蛋白(CRP)、降钙素原(PCT)、APACHEⅡ评分,对BNP数值与APACHEⅡ评分进行相关性分析,分别绘制BNP值、APACHEⅡ评分的受试者工作特征曲线(ROC曲线)。结果:死亡组患者的入院24 h内BNP值、APACHEⅡ评分高于存活组患者(808.0±583.7 vs.158.3±54.5,29.3±4.4 vs.20.3±4.1,均P<0.01)。存活组和死亡组的入院24 h内BNP数值与APACHEⅡ评分(r=0.892、r=0.758)均呈正相关,且老年重症肺炎患者入院24 h内BNP水平、APACHEⅡ评分的ROC曲线下面积为0.980和0.927。结论:死亡组患者的入院24 h内BNP水平、APACHEⅡ评分高于存活组患者,BNP可作为老年重症肺炎患者临床风险、预后的评估指标。

Objective: To investigate the value of B-type natriuretic peptide(BNP) in evaluating the clinical condition and prognosis of elderly patients with severe pneumonia. Methods: Data of 61 cases of elderly paitents ≥60 years old with severe pneumonia admitted to Department of Emergency from January 2018 to June 2019 were retrospectively analyzed. They were divided into two groups: non-survivor group(n=22) and survivor group(n=39). Serum levels of BNP,CRP,PCT and APACHE Ⅱ score in 24 hours after admission were compared between two groups. Correlation between BNP value and APACHE Ⅱ score in 24 hours after admission were analyzed. The receiver-operating characteristic cure(ROC curve) was plotted at 24 hours to analyze the accuracy of BNP level and APACHE Ⅱ score. Results: The BNP values and APACHE Ⅱ score of non-survivor group were significantly higher than those of survivor group in 24 hours after admission(808.0±583.7 vs. 158.3±54.5, 29.3±4.4 vs. 20.3±4.1, both P<0.01). In both groups, BNP values and APACHE Ⅱ score showed a positive correlation(r=0.892,r=0.758), BNP ROC and APACHE Ⅱ score ROC had an area under curve(AUC) of 0.980 and 0.927 in 24 hours after admission. Conclusion: The BNP values and APACHE Ⅱ score of non-survivor group were significantly higher than those of survivor group in 24 hours after admission. BNP can be used to assess the clinical condition and prognosis of elderly patients with severe pneumonia.