中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
10期
1132-1137
,共6页
社区获得性肺炎%B型钠尿肽%肺炎严重度评分%生物学指标%急诊%病情评估%促炎细胞因子%炎症反应
社區穫得性肺炎%B型鈉尿肽%肺炎嚴重度評分%生物學指標%急診%病情評估%促炎細胞因子%炎癥反應
사구획득성폐염%B형납뇨태%폐염엄중도평분%생물학지표%급진%병정평고%촉염세포인자%염증반응
Community-acquired pneumonia (CAP)%B-type natriuretic peptide (BNP)%Pneumonia severity index%Biomarker%Emergency%Disease severity assessment%Proinflammatorycytokine%Inflammatory reaction
目的 通过对社区获得性肺炎(community-acquired pneumonia,CAP)患者BNP(B型钠尿肽)与肺炎严重程度之间相关性的研究,评估BNP预测CAP严重程度的意义.方法 2011年12月至2012年12月就诊我科并确诊CAP患者202例,测定BNP、C-反应蛋白(CRP)、白细胞计数(WBC),以及肺炎严重度评分(PSI)所需相关指标,计算PSI评分并分级.分析不同肺炎严重程度分级之间BNP水平、C-反应蛋白、白细胞计数的差异,以及BNP与PSI的相关性.进一步根据PSI水平分为高风险组(PSI分级Ⅳ、Ⅴ级)和低风险组(PSI分级Ⅰ～Ⅲ级);根据患者预后分为存活组和死亡组.比较两组间BNP差异、BNP水平与肺炎严重程度的受试者工作特征(ROC)曲线.结果 BNP水平随着CAP严重程度增加而升高(r =0.782,P＜0.001);高风险组患者BNP水平显著高于低风险阻[(263.2±119.6)pg/mLvs.(71.5±54.3) pg/mL,P＜0.001].相比存活组,死亡组BNP水平更高[(343.86±125.49)vs.(183.00±121.71) pg/mL,P＜0.001].BNP与PSI评分、CRP以及WBC呈正相关(r=0.782,P＜0.001,r=0.560,P＜0.001和r=0.513,P＜0.001).BNP对于CAP严重程度的预测有较高的准确性(AUC =0.952),区分高、低风险的BNP最佳截点为125.0 pg/mL,敏感性0.891,特异性0.946.BNP能预测死亡(AUC =0.823),其预测死亡最佳截点为299.0 pg/mL,敏感性0.675,特异性0.816,阴性预测值0.926,阳性预测值0.426.结论 BNP与CAP严重程度呈正相关关系,BNP大于125.0 pg/mL的CAP患者建议住院治疗,BNP大于299.0 pg/mL的CAP患者具有死亡高风险.BNP预测CAP严重程度具有一定实用性.
目的 通過對社區穫得性肺炎(community-acquired pneumonia,CAP)患者BNP(B型鈉尿肽)與肺炎嚴重程度之間相關性的研究,評估BNP預測CAP嚴重程度的意義.方法 2011年12月至2012年12月就診我科併確診CAP患者202例,測定BNP、C-反應蛋白(CRP)、白細胞計數(WBC),以及肺炎嚴重度評分(PSI)所需相關指標,計算PSI評分併分級.分析不同肺炎嚴重程度分級之間BNP水平、C-反應蛋白、白細胞計數的差異,以及BNP與PSI的相關性.進一步根據PSI水平分為高風險組(PSI分級Ⅳ、Ⅴ級)和低風險組(PSI分級Ⅰ～Ⅲ級);根據患者預後分為存活組和死亡組.比較兩組間BNP差異、BNP水平與肺炎嚴重程度的受試者工作特徵(ROC)麯線.結果 BNP水平隨著CAP嚴重程度增加而升高(r =0.782,P＜0.001);高風險組患者BNP水平顯著高于低風險阻[(263.2±119.6)pg/mLvs.(71.5±54.3) pg/mL,P＜0.001].相比存活組,死亡組BNP水平更高[(343.86±125.49)vs.(183.00±121.71) pg/mL,P＜0.001].BNP與PSI評分、CRP以及WBC呈正相關(r=0.782,P＜0.001,r=0.560,P＜0.001和r=0.513,P＜0.001).BNP對于CAP嚴重程度的預測有較高的準確性(AUC =0.952),區分高、低風險的BNP最佳截點為125.0 pg/mL,敏感性0.891,特異性0.946.BNP能預測死亡(AUC =0.823),其預測死亡最佳截點為299.0 pg/mL,敏感性0.675,特異性0.816,陰性預測值0.926,暘性預測值0.426.結論 BNP與CAP嚴重程度呈正相關關繫,BNP大于125.0 pg/mL的CAP患者建議住院治療,BNP大于299.0 pg/mL的CAP患者具有死亡高風險.BNP預測CAP嚴重程度具有一定實用性.
목적 통과대사구획득성폐염(community-acquired pneumonia,CAP)환자BNP(B형납뇨태)여폐염엄중정도지간상관성적연구,평고BNP예측CAP엄중정도적의의.방법 2011년12월지2012년12월취진아과병학진CAP환자202례,측정BNP、C-반응단백(CRP)、백세포계수(WBC),이급폐염엄중도평분(PSI)소수상관지표,계산PSI평분병분급.분석불동폐염엄중정도분급지간BNP수평、C-반응단백、백세포계수적차이,이급BNP여PSI적상관성.진일보근거PSI수평분위고풍험조(PSI분급Ⅳ、Ⅴ급)화저풍험조(PSI분급Ⅰ～Ⅲ급);근거환자예후분위존활조화사망조.비교량조간BNP차이、BNP수평여폐염엄중정도적수시자공작특정(ROC)곡선.결과 BNP수평수착CAP엄중정도증가이승고(r =0.782,P＜0.001);고풍험조환자BNP수평현저고우저풍험조[(263.2±119.6)pg/mLvs.(71.5±54.3) pg/mL,P＜0.001].상비존활조,사망조BNP수평경고[(343.86±125.49)vs.(183.00±121.71) pg/mL,P＜0.001].BNP여PSI평분、CRP이급WBC정정상관(r=0.782,P＜0.001,r=0.560,P＜0.001화r=0.513,P＜0.001).BNP대우CAP엄중정도적예측유교고적준학성(AUC =0.952),구분고、저풍험적BNP최가절점위125.0 pg/mL,민감성0.891,특이성0.946.BNP능예측사망(AUC =0.823),기예측사망최가절점위299.0 pg/mL,민감성0.675,특이성0.816,음성예측치0.926,양성예측치0.426.결론 BNP여CAP엄중정도정정상관관계,BNP대우125.0 pg/mL적CAP환자건의주원치료,BNP대우299.0 pg/mL적CAP환자구유사망고풍험.BNP예측CAP엄중정도구유일정실용성.
Objective To evaluate the roles of B-type natriuretic peptide (BNP) in predicting the severity of community-acquired pneumonia (CAP) by studying the correlation between them.Methods A total of 202 patients with CAP admitted from December 2011 to December 2012 were enrolled in this study.All these patients were checked with laboratory tests for BNP level,C-reactive protein (CRP),white blood cell count (WBC) as well as other markers needed for obtaining pneumonia severity index (PSI).The differences in BNP levels,CRP levels,and WBC were compared among different degrees of pneumonia severity,and the correlation between BNP levels and PSI was investigated by a linear correlation analysis.The patients enrolled were divided into a high-risk group (defined as Ⅳ-Ⅴ grade of PSI) and a low-risk group (defined as Ⅰ-Ⅲgrade of PSI).Meanwhile,they were also divided into a survivor group and a non-survivor group according to outcomes.BNP levels between the two groups were compared,and a receiver operating characteristic (ROC) curve analysis was performed on the BNP levels versus PSI.Results BNP levels increased with CAP severity (r =0.782,P ＜0.01).The mean level of BNP (263.2 ± 119.6) pg/mLof patients in the high-risk group was significantly higher than that of patients (71.5 ± 54.3) pg/mL in the low-risk group (P ＜ 0.01).The patients in the non-survivor group had significantly higher BNP levels compared to the survivor group [(343.86 ± 125.49) vs.(183.00 ±121.71) pg/mL,P ＜ 0.01].In addition,there were positive correlations between BNP levels and PSI (r =0.782,P＜0.001),between BNP levels and CRP levels (r =0.560,P＜0.01),and between BNP levels and WBC (r =0.513,P＜0.001).The BNP level had a high accuracy in predicting the severity of CAP (AUC =0.952).The optimal cut-off point of BNP level for distinguishing high-risk from low-risk patients was 125.0 pg/mL,with a semitivity of 0.891 and a specificity of 0.946.Moreover,BNP level had a definite accuracy in predicting mortality (AUC =0.823).Its optimal cut-off point for predicting death was 299.0 pg/mL,with a sensitivity of 0.675 and a specificity of 0.816; its negative predictive cut-off value was 0.926,and positive predictive value was 0.426.Conclusions BNP level is positively correlated with the severity of CAP.The patient with BNP level above 125.0 pg/mL should be hospitalized immediately and patients with BNP level higher than 299.0 pg/mL are at the high risk of death.Therefore,BNP is a useful biomarker for evaluating the severity of patients with CAP.
