中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2013年
2期
79-82
,共4页
沈珏%顾葆春%苏磊%赵擎宇
瀋玨%顧葆春%囌磊%趙擎宇
침각%고보춘%소뢰%조경우
B型钠尿肽%重症%肿瘤患者%预后
B型鈉尿肽%重癥%腫瘤患者%預後
B형납뇨태%중증%종류환자%예후
B-type natriuretic peptide%Critically ill%Cancer patient%Prognosis
目的探讨 B 型钠尿肽(BNP)水平对肿瘤重症患者预后评估的价值.方法前瞻性观察2011年10月至2012年6月中山大学肿瘤防治中心重症医学科收治的肿瘤重症患者在进入重症监护病房(ICU)24 h 内的急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、序贯器官衰竭评分(SOFA)、血浆 BNP 水平;以28 d 为观察终点,将患者分为存活组和死亡组,比较各指标的差异.结果107例患者纳入分析,25例在观察期死亡,病死率为23.4%;患者的 BNP 水平与 APACHE Ⅱ评分(r=0.448,P<0.01)、SOFA 评分(r=0.379,P<0.01)均呈明显正相关.存活组和死亡组性别、年龄、有创通气、既往史、心率(HR)、白细胞计数(WBC)比较差异均无统计学意义(均 P>0.05).存活组血肌酐(SCr)、BNP 水平、APACHE Ⅱ评分和 SOFA评分分别是61.1(21.7~715.0)μmol/L、147.83(5.95~5000.00)ng/L、14(4~36)分和4(2~14)分,均低于死亡组的93.7(38.5~1108.0)μmol/L、304.37(38.17~4526.72)ng/L、27(5~42)分和11(2~18)分,差异均有统计学意义(均 P<0.05),而平均动脉压〔MAP:(104.0±26.8)mm Hg,1 mm Hg=0.133 kPa〕、血红蛋白〔Hb :(110.5±23.2)g/L〕明显高于死亡组〔(74.2±34.1)mm Hg、(91.7±22.7)g/L,均 P<0.01〕,住 ICU 时间(d)明显长于死亡组〔6(1~123)比3(1~31),P<0.05〕.通过比较受试者工作特征曲线(ROC 曲线)下面积(AUC)发现,在区分患者死亡与存活能力方面,BNP 与 APACHE Ⅱ、SOFA 评分系统差异均无统计学意义(r1=3.42, P1=0.064;r2=3.20,P2=0.076).Cox 比例风险回归分析表明,APACHE Ⅱ评分和 SOFA 评分是预测患者28 d病死率的独立危险因素〔相对危险度(RR1)=8.39,P1<0.001;RR2=11.64,P2<0.001〕,而 BNP 不是(RR=1.19, P=0.276).结论 BNP 水平可作为评估肿瘤重症患者近期预后的一个重要指标,但尚不能作为预测28 d 生存状态的独立危险因素.
目的探討 B 型鈉尿肽(BNP)水平對腫瘤重癥患者預後評估的價值.方法前瞻性觀察2011年10月至2012年6月中山大學腫瘤防治中心重癥醫學科收治的腫瘤重癥患者在進入重癥鑑護病房(ICU)24 h 內的急性生理學與慢性健康狀況評分繫統Ⅱ(APACHE Ⅱ)評分、序貫器官衰竭評分(SOFA)、血漿 BNP 水平;以28 d 為觀察終點,將患者分為存活組和死亡組,比較各指標的差異.結果107例患者納入分析,25例在觀察期死亡,病死率為23.4%;患者的 BNP 水平與 APACHE Ⅱ評分(r=0.448,P<0.01)、SOFA 評分(r=0.379,P<0.01)均呈明顯正相關.存活組和死亡組性彆、年齡、有創通氣、既往史、心率(HR)、白細胞計數(WBC)比較差異均無統計學意義(均 P>0.05).存活組血肌酐(SCr)、BNP 水平、APACHE Ⅱ評分和 SOFA評分分彆是61.1(21.7~715.0)μmol/L、147.83(5.95~5000.00)ng/L、14(4~36)分和4(2~14)分,均低于死亡組的93.7(38.5~1108.0)μmol/L、304.37(38.17~4526.72)ng/L、27(5~42)分和11(2~18)分,差異均有統計學意義(均 P<0.05),而平均動脈壓〔MAP:(104.0±26.8)mm Hg,1 mm Hg=0.133 kPa〕、血紅蛋白〔Hb :(110.5±23.2)g/L〕明顯高于死亡組〔(74.2±34.1)mm Hg、(91.7±22.7)g/L,均 P<0.01〕,住 ICU 時間(d)明顯長于死亡組〔6(1~123)比3(1~31),P<0.05〕.通過比較受試者工作特徵麯線(ROC 麯線)下麵積(AUC)髮現,在區分患者死亡與存活能力方麵,BNP 與 APACHE Ⅱ、SOFA 評分繫統差異均無統計學意義(r1=3.42, P1=0.064;r2=3.20,P2=0.076).Cox 比例風險迴歸分析錶明,APACHE Ⅱ評分和 SOFA 評分是預測患者28 d病死率的獨立危險因素〔相對危險度(RR1)=8.39,P1<0.001;RR2=11.64,P2<0.001〕,而 BNP 不是(RR=1.19, P=0.276).結論 BNP 水平可作為評估腫瘤重癥患者近期預後的一箇重要指標,但尚不能作為預測28 d 生存狀態的獨立危險因素.
목적탐토 B 형납뇨태(BNP)수평대종류중증환자예후평고적개치.방법전첨성관찰2011년10월지2012년6월중산대학종류방치중심중증의학과수치적종류중증환자재진입중증감호병방(ICU)24 h 내적급성생이학여만성건강상황평분계통Ⅱ(APACHE Ⅱ)평분、서관기관쇠갈평분(SOFA)、혈장 BNP 수평;이28 d 위관찰종점,장환자분위존활조화사망조,비교각지표적차이.결과107례환자납입분석,25례재관찰기사망,병사솔위23.4%;환자적 BNP 수평여 APACHE Ⅱ평분(r=0.448,P<0.01)、SOFA 평분(r=0.379,P<0.01)균정명현정상관.존활조화사망조성별、년령、유창통기、기왕사、심솔(HR)、백세포계수(WBC)비교차이균무통계학의의(균 P>0.05).존활조혈기항(SCr)、BNP 수평、APACHE Ⅱ평분화 SOFA평분분별시61.1(21.7~715.0)μmol/L、147.83(5.95~5000.00)ng/L、14(4~36)분화4(2~14)분,균저우사망조적93.7(38.5~1108.0)μmol/L、304.37(38.17~4526.72)ng/L、27(5~42)분화11(2~18)분,차이균유통계학의의(균 P<0.05),이평균동맥압〔MAP:(104.0±26.8)mm Hg,1 mm Hg=0.133 kPa〕、혈홍단백〔Hb :(110.5±23.2)g/L〕명현고우사망조〔(74.2±34.1)mm Hg、(91.7±22.7)g/L,균 P<0.01〕,주 ICU 시간(d)명현장우사망조〔6(1~123)비3(1~31),P<0.05〕.통과비교수시자공작특정곡선(ROC 곡선)하면적(AUC)발현,재구분환자사망여존활능력방면,BNP 여 APACHE Ⅱ、SOFA 평분계통차이균무통계학의의(r1=3.42, P1=0.064;r2=3.20,P2=0.076).Cox 비례풍험회귀분석표명,APACHE Ⅱ평분화 SOFA 평분시예측환자28 d병사솔적독립위험인소〔상대위험도(RR1)=8.39,P1<0.001;RR2=11.64,P2<0.001〕,이 BNP 불시(RR=1.19, P=0.276).결론 BNP 수평가작위평고종류중증환자근기예후적일개중요지표,단상불능작위예측28 d 생존상태적독립위험인소.
Objective To explore the prognostic value of B-type natriuretic peptide(BNP)level in critically ill cancer patients. Methods A prospective study was carried out,in which the clinical data of critically ill cancer patients in critical care medicine from October 2011 to June 2012 in Sun Yat-sen University Cancer Center were collected. The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,sequential organ failure assessment(SOFA)score and plasma BNP level were measured within 24 hours after admission. The patients were divided into survival group and non-survival group according to their survival status within 28 days,then clinical data were compared between the two groups. Results One hundred and seven patients were enrolled,25 patients died during the observation period and the mortality was 23.4%. There were positive correlations between BNP level and APACHE Ⅱ score(r=0.448,P<0.01),SOFA score (r=0.379,P<0.01)respectively. There were no statistical differences in sex,age,cases of mechanical ventilation application,past medical history,heart rate(HR) and white blood cell count(WBC)between two groups(all P>0.05). The serum creatinine(SCr),BNP level, APACHE Ⅱ score and SOFA score in survival group were lower than those in non-survival group〔61.1(21.7 -715.0)μmol/L vs. 93.7(38.5 - 1108.0)μmol/L,147.83(5.95 - 5000.00)ng/L vs. 304.37(38.17 - 4526.72)ng/L, 14(4 - 36)vs. 27(5 - 42),4(2 - 14)vs. 11(2 - 18),all P<0.05〕. The mean arterial pressure(MAP),hemoglobin (Hb)in survival group were significantly higher than those in non-survival group〔MAP(mm Hg,1 mm Hg=0.133 kPa):104.0±26.8 vs. 74.2±34.1,Hb(g/L):110.5±23.2 vs. 91.7±22.7,both P<0.01〕. The intensive care unit(ICU)stay(day)in survival group was significantly longer than that in non-survival group〔6(1 - 123) vs. 3(1 - 31),P<0.05〕. From the comparisons between the areas under curve(AUC)in the graph of the receiver operating characteristic curves(ROC curves),it was shown that BNP did have the same ability as that of APACHE Ⅱscore and SOFA score in discriminating survivors and non-survivors(r1=3.42,P1=0.064 ;r2=3.20,P2=0.076). Cox proportional hazards regression analysis indicated that APACHE Ⅱ score and SOFA score both could be the independent risk factors to predict the 28-day mortality〔relative risk(RR1)=8.39,P1<0.001 ;RR2=11.64,P2<0.001〕,while BNP level was not(RR=1.19,P=0.276). Conclusion BNP can be an important prognostic indicator of short-term outcome,but not an independent risk factor to predict the survival status of critically ill cancer patients in 28 days of observation.
