血清Hcy、BNP、hs-CRP、CK-MB水平与老年社区获得性肺炎病情程度及预后的关系

Relationship of Serum Levels of Hcy,BNP,hs-CRP and CK-MB with the Severity and Prognosis of Community-acquired Pneumonia in the Elderly

目的研究血清同型半胱氨酸(Hcy)、脑钠肽(BNP)、超敏C反应蛋白(hs-CRP)、心肌型肌酸激酶同工酶(CK-MB)水平与老年社区获得性肺炎患者病情程度及预后的关系。方法回顾性分析2017年3月—2022年3月收治的168例老年社区获得性肺炎临床资料。根据临床肺部感染评分(CPIS)对病情程度进行评估,将患者分为轻度组(CPIS评分<6分)88例与重度组(CPIS评分≥6分)80例。患者出院后随访1个月,根据存活情况将患者分为预后良好组134例及预后不良组34例。比较轻度组与重度组基线资料及Hcy、BNP、hs-CRP、CK-MB水平,通过Spearman相关系数分析患者病情程度与血清Hcy、BNP、hs-CRP、CK-MB水平的相关性;比较不同预后患者基线资料及Hcy、BNP、hs-CRP、CK-MB水平,并通过受试者工作特征(ROC)曲线分析Hcy、BNP、hs-CRP、CK-MB及四者联合预测患者预后不良的价值。结果轻度组Hcy、BNP、hs-CRP、CK-MB水平低于重度组(P<0.01)。Hcy、BNP、hs-CRP、CK-MB水平与老年社区获得性肺炎患者病情程度呈正相关(r=0.475、0.623、0.469、0.517,P<0.01)。预后良好组Hcy、BNP、hs-CRP、CK-MB水平低于预后不良组(P<0.01)。经ROC曲线分析证实,Hcy、BNP、hs-CRP、CK-MB及四者联合预测老年社区获得性肺炎患者预后不良的曲线下面积为0.828、0.885、0.930、0.937、0.958,联合预测的曲线下面积最大。结论Hcy、BNP、hs-CRP、CK-MB水平与老年社区获得性肺炎病情程度呈正相关,同时可以预测老年社区获得性肺炎患者预后。

Objective To investigate the relationship of serum homocysteine(Hcy),brain natriuretic peptide(BNP),hypersensitive C reactive protein(hs-CRP),creatine kinase-myocardial band isoenzyme(CK-MB)levels with the severity and prognosis of elderly patients with community-acquired pneumonia.Methods The clinical data of 168 elderly patients with community-acquired pneumonia admitted from March 2017 to March 2022 were retrospectively analyzed.Clinical pulmonary infection score(CPIS)was used to evaluate the severity of the disease,and the patients were divided into mild group(CPIS score<6,n=88)and severe group(CPIS score≥6,n=80).Patients were followed up for 1 month after discharge,and were divided into good prognosis group(n=134)and poor prognosis group(n=34)according to their survival.Baseline data and the levels of Hcy,BNP,hs-CRP and CK-MB in mild and severe groups were compared.Spearman correlation coefficient was used to analyze the correlation between the severity of patients'disease and serum levels of Hcy,BNP,hs-CRP and CK-MB.Baseline data and the levels of Hcy,BNP,hs-CRP and CK-MB in patients with different prognosis were compared,and the value of Hcy,BNP,hs-CRP,CK-MB and the combination of the four in predicting poor prognosis was analyzed by receiver operating characteristic(ROC)curve.Results The levels of Hcy,BNP,hs-CRP and CK-MB in mild group were significantly lower than those in severe group(P<0.01).The levels of Hcy,BNP,hs-CRP and CK-MB were positively correlated with the severity of community-acquired pneumonia in elderly patients(r=0.475,0.623,0.469,0.517,P<0.01).The levels of Hcy,BNP,hs-CRP and CK-MB in good prognosis group were lower than those in poor prognosis group(P<0.01).ROC curve analysis confirmed that the area under the ROC curve(AUC)of Hcy,BNP,hs-CRP,CK-MB alone and in combination to predict the poor prognosis of elderly patients with community-acquired pneumonia was 0.828,0.885,0.930,0.937,0.958,and the AUC of the combined prediction was the largest.Conclusion The levels of Hcy,BNP,hs-CRP and CK-MB are positively correlated with the severity of community-acquired pneumonia in elderly patients,and can predict the prognosis of community-acquired pneumonia in elderly patients.