CAJ | 학술논문

目的：探讨呼吸机相关性肺炎( VAP)患者中血浆氨基末端B型钠利尿肽前体( NT-proBNP)的变化意义。方法2011年4月至2014年4月我院接受机械通气治疗的168例患者,按照治疗期间是否发生VAP分为Ⅰ组(出现VAP,n=62例)和Ⅱ组(无VAP,n=106例),检测两组患者的血浆NT-proBNP水平,并记录两组患者一般临床资料、确诊时急性生理和慢性健康评价指标Ⅱ( APACHEⅡ)评分及实验室检查指标；将Ⅰ组按照血浆NT-proBNP分为正常组及增高组,比较两组相关实验室检查指标及住院死亡率；并利用Lo-gistic回归模型分析CAP患者住院期间的死亡因素。结果Ⅰ组血浆NT-proBNP、APACHEⅡ评分、血糖及WBC计数明显高于Ⅱ组( P<0．05),而血清白蛋白水平低于Ⅱ组( P<0．05)；NT-proBNP增高组死亡率高于正常组(P<0．05)；经pearson相关分析显示：血浆NT-proBNP与APACHEⅡ评分(r=0．502,P<0．05)、CRP (r=0．513,P<0．05),WBC计数(r=0．339,P<0．05)及血糖水平(r=0．311,P<0．05)呈正相关；多因素Lo-gistic回归分析显示：血浆NT-proBNP水平(OR=2．012,P<0．05)是VAP患者预后的高危因素。结论 VAP患者中血浆NT-proBNP水平显著增高且与炎症反应密切相关,是CAP患者住院期间死亡的独立预测因素,血浆NT-proBNP水平在评估CAP患者病情及近期预后方面具有一定的临床价值。
목적：탐토호흡궤상관성폐염( VAP)환자중혈장안기말단B형납이뇨태전체( NT-proBNP)적변화의의。방법2011년4월지2014년4월아원접수궤계통기치료적168례환자,안조치료기간시부발생VAP분위Ⅰ조(출현VAP,n=62례)화Ⅱ조(무VAP,n=106례),검측량조환자적혈장NT-proBNP수평,병기록량조환자일반림상자료、학진시급성생리화만성건강평개지표Ⅱ( APACHEⅡ)평분급실험실검사지표；장Ⅰ조안조혈장NT-proBNP분위정상조급증고조,비교량조상관실험실검사지표급주원사망솔；병이용Lo-gistic회귀모형분석CAP환자주원기간적사망인소。결과Ⅰ조혈장NT-proBNP、APACHEⅡ평분、혈당급WBC계수명현고우Ⅱ조( P<0．05),이혈청백단백수평저우Ⅱ조( P<0．05)；NT-proBNP증고조사망솔고우정상조(P<0．05)；경pearson상관분석현시：혈장NT-proBNP여APACHEⅡ평분(r=0．502,P<0．05)、CRP (r=0．513,P<0．05),WBC계수(r=0．339,P<0．05)급혈당수평(r=0．311,P<0．05)정정상관；다인소Lo-gistic회귀분석현시：혈장NT-proBNP수평(OR=2．012,P<0．05)시VAP환자예후적고위인소。결론 VAP환자중혈장NT-proBNP수평현저증고차여염증반응밀절상관,시CAP환자주원기간사망적독립예측인소,혈장NT-proBNP수평재평고CAP환자병정급근기예후방면구유일정적림상개치。
Objective To investigate the clinical significance of plasma NT-proBNP changes in patients with ventilator associated pneumonia ( VAP ) . Methods 168 patients received mechanical ventilation treatment in our hospital ICU from April 2011 to April 2014 were sleeted as research subjects, and then were divided into theⅠgroup (the VAP group, n=62) and the Ⅱ group (the non-VAP group, n=106) according to the presence of VAP. The level of plasma NT-proBNP in the two groups were detected, and the general clinical data, the clinical history, me-chanical ventilation time, APACHEⅡ score and laboratory examination indexes were recorded. Patients in the Ⅰgroup were divided into the increased NT-proBNP group and the normal BNP group. CRP, APACHEⅡscore, labora-tory examination indexes and mortality were compared between the two groups. Results Compared with the Ⅱgroup, the level of NT-proBNP in theⅠgroup increased significantly (P<0. 05), APACHEⅡscore, blood glucose and WBC count also increased significantly (P<0. 05), but serum albumin decreased (P<0. 05). Compared with the normal NT-proBNP group, CRP, APACHEⅡ score, blood glucose and WBC count increased significantly in the increased NT-proBNP group (P<0. 05), and the mortality also increased (P<0. 05). Pearson correlation analysis showed that the level of plasma NT-proBNP were positively correlated with CRP (r=0. 513, P<0. 05), WBC count (r=0. 339, P<0. 05), and APACHEⅡ score (r=0. 502, P<0. 05) respectively. The multi-variable logistic re-gression analysis showed that plasma NT-proBNP (OR=2. 012, P<0. 05) was the high risk factor for recent progno-sis of patients with VAP. Conclusion Plasma NT-proBNP is closely related with the inflammatory reaction in VAP, and significantly higher in patients with VAP. Plasma NT-proBNP is the independent risk factor of VAP in hospital, and the indexes can play a certain clinical value in evaluation of VAP condition and prognosis.