血清尿素氮与肌酐比值与老年重症肺炎患者心功能的关系

The relationship between serum blood urea nitrogen to creatinine ratio and cardiac function in elderly patients with severe pneumonia

目的探讨血清尿素氮与肌酐比值(UCR)与老年重症肺炎患者心功能的关系。方法回顾性选取2020年5月至2023年4月皖北煤电集团总医院收治的100例老年重症肺炎患者为病例组,另选取50例同期进行健康体检者为对照组。检测两组血清尿素氮(BUN)、肌酐(Cr)、UCR、心肌损伤指标[心肌肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-ProBNP)、肌酸激酶(CK)、肌酸激酶同工酶MB(CK-MB)]及心功能指标[左心室射血分数(LVEF)、心输出量(CO)、每搏输出量(SV)及心脏排血指数(CI)];病例组患者依据住院期间心功能不全发生情况分为心功能不全亚组与心功能正常亚组。比较病例组与对照组血清UCR、心肌损伤与心功能指标,比较心功能不全亚组与心功能正常亚组一般资料、心肌损伤与心功能指标,采用双变量Pearson相关性分析血清UCR与重症肺炎患者心功能的关系;用Logistic回归模型分析重症肺炎患者心功能不全的影响因素,采用受试者工作特征(ROC)曲线分析血清UCR预测重症肺炎患者心功能不全的价值。结果病例组BUN、UCR、cTnI、NT-ProBNP、CK、CK-MB水平大于对照组[(8.72±1.14)μmol/L比(6.41±0.76)μmol/L、125.00±19.75比86.12±12.02、0.04(0.03,0.05)μg/L比0.04(0.03,0.05)μg/L、(185.49±20.59)ng/L比(147.76±20.85)ng/L、(104.78±14.98)U/L比(99.33±15.07)U/L、(31.59±6.23)U/L比(29.13±5.76)U/L],Cr、LVEF、CO、SV、CI小于对照组[(70.22±5.76)μmol/L比(74.75±5.12)μmol/L、(59.72±2.41)%比(61.78±2.16)%、(3.93±0.43)L/min比(4.53±0.62)L/min、(59.82±6.12)ml比(62.23±7.22)ml、(2.95±0.30)L/(min·m^(2))比(3.06±0.33)L/(min·m^(2))],差异有统计学意义(P<0.05)。病例组患者住院期间21例患者出现心功能不全;心功能不全亚组入院时肺炎严重指数评分高于心功能正常亚组[(172.76±9.18)分比(168.24±8.81)分],血清BUN、UCR水平高于心功能正常亚组[(9.51±0.79)mmol/L比(8.51±1.13)mmol/L、141.62±9.89比120.59±19.39],血清Cr水平低于心功能正常亚组[(67.26±5.34)μmol/L比(71.00±5.65)μmol/L],差异有统计学意义(P<0.05);两亚组其他资料比较差异无统计学意义(P>0.05);双变量Pearson相关性分析显示,血清UCR与重症肺炎心功能指标cTnI、NT-ProBNP、CK、CK-MB水平呈正相关关系(r=0.40、0.27、0.32、0.33,P<0.05),与LVEF、CO、SV、CI水平呈负相关关系(r=-0.37、-0.21、-0.25、-0.21,P<0.05);单因素及多因素Logistic回归分析结果显示,老年重症肺炎患者心功能不全的发生可能与入院时肺炎严重指数评分及血清BUN、UCR、Cr水平异常表达有关(P<0.05);ROC曲线分析发现,入院时血清UCR预测重症肺炎患者住院期间心功能不全发生的曲线下面积为0.85(95%CI 0.77~0.92),具有一定预测价值。结论老年重症肺炎患者伴随着一定程度的血清UCR水平升高,且血清UCR水平越高其心功能损伤越重,心功能不全发生风险越大。

ObjectiveTo explore the relationship between serum urea nitrogen to creatinine ratio(UCR)and cardiac function in elderly patients with severe pneumonia.MethodsA prospective selection of 100 elderly patients with severe pneumonia admitted to Group Wanbei General Hospital of Wanbei Coal Power from May 2020 to April 2023 was conducted as the case group,and an additional 50 patients who underwent health examinations in the hospital during the same period were selected as the control group.Serum urea nitrogen(BUN),creatinine(Cr),UCR value,myocardial injury indexes:cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-ProBNP),creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB),and cardiac function indexes:left ventricular ejection fraction(LVEF),cardiac output(CO),stroke volume(SV)and cardiac output index(CI)were detected in the two groups.The patients in the case group were divided into two subgroups based on the occurrence of heart failure during hospitalization:the heart failure subgroup and the normal heart function subgroup.The serum UCR,myocardial injury and cardiac function indexes were compared between the case group and the control group.The general data,myocardial injury and cardiac function indexes were compared between the heart failure group and the normal heart function group.The relationship between serum UCR and cardiac function in patients with severe pneumonia was analyzed by bivariate Pearson correlation.Logistic regression model was used to analyze the influencing factors of cardiac dysfunction in patients with severe pneumonia,and using receiver operating characteristic(ROC)curve to analyze the value of serum UCR in predicting cardiac dysfunction in patients with severe pneumonia.ResultsThe values of BUN,UCR,cTnI,NT-ProBNP,CK and CK-MB in the case group were higher than those in the control group:(8.72±1.14)μmol/L vs.(6.41±0.76)μmol/L,125.00±19.75 vs.86.12±12.02,0.04(0.03,0.05)μg/L vs.0.04(0.03,0.05)μg/L,(185.49±20.59)ng/L vs.(147.76±20.85)ng/L,(104.78±14.98)U/L vs.(99.33±15.07)U/L,(31.59±6.23)U/L vs.(29.13±5.76)U/L.The values of Cr,LVEF,CO,SV and CI in the observation group were lower than those in the control group:(70.22±5.76)μmol/L vs.(74.75±5.12)μmol/L,(59.72±2.41)%vs.(61.78±2.16)%,(3.93±0.43)L/min vs.(4.53±0.62)L/min,(59.82±6.12)ml vs.(62.23±7.22)ml,(2.95±0.30)L/(min·m^(2))vs.(3.06±0.33)L/(min·m^(2)),with a statistical significant difference(P<0.05).In the case group,21 patients had heart failure during hospitalization,accounting for 21.00%.The pneumonia severity index score on admission in the heart failure subgroup was higher than that in the normal heart function subgroup:(172.76±9.18)points vs.(168.24±8.81)points.The serum BUN and UCR levels were higher than those in the normal heart function subgroup:(9.51±0.79)mmol/L vs.(8.51±1.13)mmol/L,141.62±9.89 vs.120.59±19.39.The serum Cr level was lower than that in the normal heart function subgroup:(67.26±5.34)μmol/L vs.(71.00±5.65)μmol/L,with a significant statistical difference(P<0.05).There was no significant statistical difference in other data between the two subgroups(P>0.05).The bivariate Pearson correlation analysis showed that serum UCR was positively correlated with cardiac function indicators cTnI,NT-ProBNP,CK and CK-MB levels in severe pneumonia(r=0.40,0.27,0.32 and 0.33;P<0.05),and negatively correlated with LVEF,CO,SV and CI levels(r=-0.37,-0.21,-0.25 and-0.21;P<0.05).Univariate and multivariate Logistic regression analysis showed that the occurrence of cardiac dysfunction in elderly patients with severe pneumonia may be related to the pneumonia severity index score on admission and the abnormal expression of serum BUN,UCR and Cr levels(P<0.05).ROC curve analysis found that the area under the curve for predicting the occurrence of cardiac dysfunction during hospitalization in severe pneumonia patients with serum UCR on admission was 0.85(95%CI 0.77 to 0.92),which had certain predictive value.ConclusionsElderly patients with severe pneumonia are accompanied by a certain degree of elevated serum UCR levels,and the higher the serum UCR level,the more severe the cardiac function damage and the greater the risk of cardiac dysfunction.