NT-pro-BNP、D-D、PCT和乳酸检测评估社区获得性肺炎预后的临床价值研究

Clinical value of NT-Pro-BNP,D-D,PCT and lactic acid in evaluating the prognosis of community-acquired pneumonia

目的探讨N末端B型脑利钠肽前体(NT-pro-BNP)、D二聚体(D-D)、降钙素原(PCT)和乳酸水平评估社区获得性肺炎(CAP)患者预后的价值。方法纳入2018年1月至2020年10月临床诊断为CAP患者133例,患者入院时采集血样后行NT-pro-BNP、D-D、PCT和乳酸检测。采用χ^(2)检验分析组间的性别,t检验分析组间的年龄差异,非参数Mann Whitney U检验对NT-pro-BNP、D-D、PCT和乳酸检验结果进行分析,数值以中位数(四分位间距)M(IQR)表示,使用英国胸科协会改良肺炎评分(CURB-65)计算患者的病情严重程度,以入院后30 d死亡为研究终点,探究上述4种生物标志物预测CAP短期死亡的能力,使用受试者工作特征曲线(ROC)比较NT-pro-BNP、D-D、PCT和乳酸对CAP 30 d死亡的预测能力,以曲线下面积(AUC)判断诊断效果,二元逻辑回归用于分析上述4种生物标志物预测CAP患者30 d的病死率,所有的检验结果以P<0.05为差异有统计学意义。结果CAP的病死率为15.0%(20/133),相比幸存组,死亡组的NT-pro-BNP、D-D、PCT和乳酸在患者入院第1天的血液中被检出的水平较高,检测值分别为1481.0(664.3,7487.5)pg/mL、6.37(3.74,9.62)mg/L、3.83(1.96,7.48)ng/mL和3.60(2.63,4.17)mmol/L,其差异具有统计学意义(P值均<0.05)。4种指标均能较好地预测CAP患者临床结局,以PCT为最佳预测独立因子,当PCT截断值为1.76 ng/mL时,其预测患者短期死亡的AUC为0.925,灵敏度和特异度达85.0%和85.0%。体内高水平PCT的患者短期死亡风险是低水平PCT患者的3.81倍。结论NT-pro-BNP、D-D、PCT和乳酸是预测CAP病情分层的较好生物标志物,高水平的PCT能准确预测CAP患者短期死亡风险。

Objective To evaluate the prognostic value of N-terminal B-type brain natriuretic peptide precursor(NT-pro-BNP),D-dimer(D-D),procalcitonin(PCT)and lactic acid levels in patients with community-acquired pneumonia(CAP).Methods A total of 133 patients with CAP clinically diagnosed from January 2018 to October 2020 were included.Blood samples were collected at admission and then tested for NT-Pro-BNP,D-D,PCT and lactic acid.χ^(2) test was used to analyze the gender between the groups,t test was used to analyze the age differences between the groups,and non-parametric Mann Whitney U test was used to analyze the results of NT-Pro-BNP,D-D,PCT and lactic acid tests,and the values were expressed as median(interquaternary interval)M(IQR).CURB-65 was used to calculate the severity of the patient's illness and to investigate the ability of the four biomarkers to predict short-term death from CAP,with death in 30 days after admission as the end point.Receiver operating characteristic curve(ROC)was used to compare the predictive ability of NT-Pro-BNP,D-D,PCT and lactic acid on 30-day mortality of CAP patients,and the area under the curve(AUC)was used to determine the diagnostic effect.Binary logic regression was used to analyze the 30-day mortality of CAP patients predicted by the above 4 biomarkers.All the test results were statistically significant with P<0.05.Results The case fatality rate of CAP was 15.0%(20/133).Compared with the survival group,higher levels of NT-Pro-BNP,D-D,PCT,and lactic acid were detected in the blood of the death group on day 1 of admission with values of 1481.0(664.3,7487.5)pg/mL,6.37(3.74,9.62)mg/L,3.83(1.96,7.48)ng/mL and 3.60(2.63,4.17)mmol/L,with statistically significant differences(P<0.05).All of the four indexes could well predict the clinical outcome of patients with CAP.PCT was the best independent predictor.When the cut-off value of PCT was 1.76 ng/mL,the AUC of predicting short-term death of patients was 0.925,and the sensitivity and specificity were 85.0%and 85.0%.Patients with high levels of PCT had a 3.81-fold higher risk of short-term death than those with low levels.Conclusion NT-Pro-BNP,D-D,PCT and lactic acid are good biomarkers for predicting disease stratification in CAP,and high level of PCT can accurately predict the short-term risk of death in CAP patients.