重症肺炎所致ARDS患者血NT-proBNP、CRP/ALB相关性及联合预测预后效能分析

Analysis of the correlation between blood NT-proBNP and CRP/ALB in patients with ARDS caused by severe pneumonia and the effectiveness of the combined predicting prognosis

目的探讨重症肺炎所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者血氨基末端脑钠肽前体(N-terminal pro brainnatriuretic peptide,NT-proBNP)、C反应蛋白(C-reactive protein,CRP)/白蛋白(albumin,ALB)相关性及联合预测预后效能。方法选取2018年12月-2020年6月北京中医药大学房山医院112例重症肺炎所致ARDS患者,根据患者出院后1周内是否死亡或直接院内死亡分为死亡组(n=31)与生存组(n=81)。对比不同病情程度患者血NT-proBNP、CRP/ALB,分析NT-proBNP、CRP/ALB与病情程度相关性及NT-proBNP、CRP/ALB间相关性,对比不同预后患者临床资料、血NT-proBNP、CRP/ALB,并进行重症肺炎所致ARDS患者预后影响因素及偏相关性分析,最后以受试者工作特征(receiver operating characteristic curve,ROC)曲线评估NT-proBNP、CRP/ALB对重症肺炎所致ARDS患者预后的预测价值。结果重症肺炎所致ARDS患者NT-proBNP、CRP、CRP/ALB均与病情程度呈正相关(P<0.05),且NT-proBNP与CRP、CRP/ALB呈正相关关系(P<0.05);经多元线性回归分析可知,体温、脉搏、动脉氧分压(arterial oxygen partial pressure,PaO_(2))、NT-proBNP、CRP、CRP/ALB均为重症肺炎所致ARDS患者预后影响因素(P<0.05),偏相关性将体温、脉搏、PaO_(2)等其他因素控制后,NT-proBNP、CRP、CRP/ALB仍与重症肺炎所致ARDS患者预后显著相关(P<0.05);分别绘制各指标单一、联合预测重症肺炎所致ARDS患者预后的ROC曲线,显示各指标联合预测重症肺炎所致ARDS患者预后的AUC面积最大,为0.909(95%CI为0.846~0.973),敏感度为74.19%,特异度为93.83%。结论重症肺炎所致ARDS患者NT-proBNP、CRP/ALB随病情严重程度加重而升高,且二者呈正相关关系,联合检测NT-proBNP、CRP/ALB可预测患者预后,为临床治疗策略制定提供参考依据。

Objective To investigate the correlation between blood N-terminal pro brainnatriuretic peptide(NT-proBNP),C-reactive protein(CRP)/albumin(ALB)and the combined prognostic efficacy of patients with acute respiratory distress syndrome(ARDS)caused by severe pneumonia.Methods A total of 112 patients with ARDS caused by severe pneumonia in our hospital from December 2018 to June 2020 were selected.According to whether the patients died within 1 week after discharge or died directly in the hospital,they were divided into death group(n=31)and survival group(n=81).The blood NT-proBNP and CRP/ALB of patients with different disease levels were compared,and the correlation between NT-proBNP,CRP/ALB and the disease level and the correlation between NT-proBNP and CRP/ALB were analyzed.The clinical data,blood NT-proBNP,CRP/ALB of patients with different prognosis were compared,and the prognostic factors and partial correlation analysis of ARDS patients caused by severe pneumonia were performed.Finally,the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of NT proBNP and CRP/ALB on the prognosis of ARDS patients caused by severe pneumonia.Results NT-proBNP,CRP and CRP/ALB in ARDS patients caused by severe pneumonia were positively correlated with the severity of the disease(P<0.05),and NT-proBNP was positively correlated with CRP and CRP/ALB(P<0.05).The multiple linear regression analysis showed that body temperature,pulse,PaO_(2),NT-proBNP,CRP,and CRP/ALB were all prognostic factors in ARDS patients caused by severe pneumonia(P<0.05).After controlling body temperature,pulse,PaO_(2) and other factors with partial correlation,NT-proBNP,CRP,CRP/ALB were still significantly related to the prognosis of ARDS patients caused by severe pneumonia(P<0.05).The ROC curve of each index single and combined predicting the prognosis of ARDS patients caused by severe pneumonia was drawn,showing that the AUC area of each index combined predicting the prognosis of ARDS patients caused by severe pneumonia was the largest,which was 0.909(95%CI 0.846~0.973),the sensitivity was 74.19%,and the specificity was 93.83%.Conclusion NT-proBNP and CRP/ALB in ARDS patients caused by severe pneumonia increase with the severity of the disease,and there is a positive correlation between the two.Combined detection of NT-proBNP and CRP/ALB can predict the prognosis of patients and provide a strong basis for the formulation of clinical treatment strategies.