中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
19期
2301-2305
,共5页
张帅%张虹霞%林蕊艳%韩芳%张淑明%胥振阳
張帥%張虹霞%林蕊豔%韓芳%張淑明%胥振暘
장수%장홍하%림예염%한방%장숙명%서진양
社区获得性感染%肺炎,细菌性%氮末端脑钠肽前体%降钙素
社區穫得性感染%肺炎,細菌性%氮末耑腦鈉肽前體%降鈣素
사구획득성감염%폐염,세균성%담말단뇌납태전체%강개소
Community-acquired infections%Pneumonia,bacterial%N-terminal pro-BNP%Calcitonin
目的:了解氮末端脑钠肽前体( NT-proBNP)在不同降钙素原( PCT)水平社区获得性肺炎( CAP)患者中的临床意义。方法选取2012年1月—2013年12月,在首都医科大学附属北京潞河医院接受住院治疗的CAP患者287例。根据PCT水平,将其分为A(PCT<0.10μg/L,n=110)、B(0.10μg/L≤PCT≤0.25μg/L,n=99)、C (0.25μg/L<PCT≤0.50μg/L,n=31)、D(PCT>0.50μg/L,n=47)4组。比较并分析4组患者一般临床资料和各项实验室检测指标,分析NT-proBNP与炎性标志物、全血肌钙蛋白I( TNI)及肺炎严重度指数( PSI)的相关性。结果(1)4组患者性别、平均年龄及合并症中的糖尿病比较,差异有统计学意义( P<0.05);合并症中慢性阻塞性肺疾病、哮喘、高血压、冠心病、心房纤颤及脑血管疾病比较,差异无统计学意义(P>0.05)。(2)4组患者体温、心率、呼吸频率、PCT、NT-proBNP、氢离子浓度指数(pH)、氧分压(PO2)、氧合指数、白细胞计数(WBC)、中性粒细胞计数(NEUT)、红细胞沉降率(ESR)、C -反应蛋白(CRP)及 PSI 评分比较,差异有统计学意义(P <0.05);收缩压、舒张压、TNI 及二氧化碳分压(PCO2)比较,差异无统计学意义(P >0.05)。(3)A 组患者NT-proBNP与C、D组比较,差异有统计学意义( P<0.05);B组患者NT-proBNP与C、D组比较,差异有统计学意义(P<0.05);C组患者NT-proBNP与D 组比较,差异有统计学意义(P <0.05)。(4)Spearman 相关分析显示, NT-proBNP与TNI(rs =0.21,P <0.05)、PCT(rs =0.30,P <0.05)、WBC(rs =0.15,P <0.05)、NEUT(rs=0.25,P<0.05)、ESR(rs =0.23,P<0.05)、CRP(rs =0.40,P<0.05)及PSI(rs =0.54,P<0.05)均呈正相关。以PCT>0.25μg/L为截点,进一步行Spearman相关分析,结果显示,细菌感染患者中NT-proBNP与PCT呈正相关(rs =0.40,P=0.00)。结论细菌感染加重可以导致患者NT-proBNP水平增高,可能是由细菌内毒素通过炎性递质介导,推测NT-proBNP可以作为反映CAP患者病情严重程度和预后的指标。
目的:瞭解氮末耑腦鈉肽前體( NT-proBNP)在不同降鈣素原( PCT)水平社區穫得性肺炎( CAP)患者中的臨床意義。方法選取2012年1月—2013年12月,在首都醫科大學附屬北京潞河醫院接受住院治療的CAP患者287例。根據PCT水平,將其分為A(PCT<0.10μg/L,n=110)、B(0.10μg/L≤PCT≤0.25μg/L,n=99)、C (0.25μg/L<PCT≤0.50μg/L,n=31)、D(PCT>0.50μg/L,n=47)4組。比較併分析4組患者一般臨床資料和各項實驗室檢測指標,分析NT-proBNP與炎性標誌物、全血肌鈣蛋白I( TNI)及肺炎嚴重度指數( PSI)的相關性。結果(1)4組患者性彆、平均年齡及閤併癥中的糖尿病比較,差異有統計學意義( P<0.05);閤併癥中慢性阻塞性肺疾病、哮喘、高血壓、冠心病、心房纖顫及腦血管疾病比較,差異無統計學意義(P>0.05)。(2)4組患者體溫、心率、呼吸頻率、PCT、NT-proBNP、氫離子濃度指數(pH)、氧分壓(PO2)、氧閤指數、白細胞計數(WBC)、中性粒細胞計數(NEUT)、紅細胞沉降率(ESR)、C -反應蛋白(CRP)及 PSI 評分比較,差異有統計學意義(P <0.05);收縮壓、舒張壓、TNI 及二氧化碳分壓(PCO2)比較,差異無統計學意義(P >0.05)。(3)A 組患者NT-proBNP與C、D組比較,差異有統計學意義( P<0.05);B組患者NT-proBNP與C、D組比較,差異有統計學意義(P<0.05);C組患者NT-proBNP與D 組比較,差異有統計學意義(P <0.05)。(4)Spearman 相關分析顯示, NT-proBNP與TNI(rs =0.21,P <0.05)、PCT(rs =0.30,P <0.05)、WBC(rs =0.15,P <0.05)、NEUT(rs=0.25,P<0.05)、ESR(rs =0.23,P<0.05)、CRP(rs =0.40,P<0.05)及PSI(rs =0.54,P<0.05)均呈正相關。以PCT>0.25μg/L為截點,進一步行Spearman相關分析,結果顯示,細菌感染患者中NT-proBNP與PCT呈正相關(rs =0.40,P=0.00)。結論細菌感染加重可以導緻患者NT-proBNP水平增高,可能是由細菌內毒素通過炎性遞質介導,推測NT-proBNP可以作為反映CAP患者病情嚴重程度和預後的指標。
목적:료해담말단뇌납태전체( NT-proBNP)재불동강개소원( PCT)수평사구획득성폐염( CAP)환자중적림상의의。방법선취2012년1월—2013년12월,재수도의과대학부속북경로하의원접수주원치료적CAP환자287례。근거PCT수평,장기분위A(PCT<0.10μg/L,n=110)、B(0.10μg/L≤PCT≤0.25μg/L,n=99)、C (0.25μg/L<PCT≤0.50μg/L,n=31)、D(PCT>0.50μg/L,n=47)4조。비교병분석4조환자일반림상자료화각항실험실검측지표,분석NT-proBNP여염성표지물、전혈기개단백I( TNI)급폐염엄중도지수( PSI)적상관성。결과(1)4조환자성별、평균년령급합병증중적당뇨병비교,차이유통계학의의( P<0.05);합병증중만성조새성폐질병、효천、고혈압、관심병、심방섬전급뇌혈관질병비교,차이무통계학의의(P>0.05)。(2)4조환자체온、심솔、호흡빈솔、PCT、NT-proBNP、경리자농도지수(pH)、양분압(PO2)、양합지수、백세포계수(WBC)、중성립세포계수(NEUT)、홍세포침강솔(ESR)、C -반응단백(CRP)급 PSI 평분비교,차이유통계학의의(P <0.05);수축압、서장압、TNI 급이양화탄분압(PCO2)비교,차이무통계학의의(P >0.05)。(3)A 조환자NT-proBNP여C、D조비교,차이유통계학의의( P<0.05);B조환자NT-proBNP여C、D조비교,차이유통계학의의(P<0.05);C조환자NT-proBNP여D 조비교,차이유통계학의의(P <0.05)。(4)Spearman 상관분석현시, NT-proBNP여TNI(rs =0.21,P <0.05)、PCT(rs =0.30,P <0.05)、WBC(rs =0.15,P <0.05)、NEUT(rs=0.25,P<0.05)、ESR(rs =0.23,P<0.05)、CRP(rs =0.40,P<0.05)급PSI(rs =0.54,P<0.05)균정정상관。이PCT>0.25μg/L위절점,진일보행Spearman상관분석,결과현시,세균감염환자중NT-proBNP여PCT정정상관(rs =0.40,P=0.00)。결론세균감염가중가이도치환자NT-proBNP수평증고,가능시유세균내독소통과염성체질개도,추측NT-proBNP가이작위반영CAP환자병정엄중정도화예후적지표。
Objective To investigate the clinical significance of N-terminal pro-BNP( NT-proBNP)for patients with community-acquired pneumonia( CAP)of different PCT levels. Methods We enrolled 287 CAP patients who received hospitalized treatment in Beijing Luhe Hospital Affiliated to Captial Medical University from January 2012 to December 2013. According to serum PCT level,the subjects were divided into four groups:group A(PCT<0. 10μg/L,n=110),group B(0. 10 μg/L≤PCT≤0. 25 μg/L,n=99),group C(0. 25 μg/L<PCT≤0. 50 μg/L,n=31)and group D(PCT>0. 50μg/L,n=47). The general clinical data and each laboratory examination indicator were analyzed and compared among the four groups,and the correlation between NT-proBNP and inflammatory markers,TNI and PSI was analyzed. Results (1) The four groups were significantly different(P<0. 05)in gender,average age and diabetes mellitus in complications and were not significantly different(P >0. 05)in chronic obstructive pulmonary disease,asthma,hypertension,coronary heart disease, atrial fibrillation and cerebrovascular diseases in complications. (2)The four groups were significantly different(P<0. 05)in temperature,heart rate,respiratory rate,PCT,NT-proBNP,PH,PO2,oxygenation index,WBC,NEUT,ESR,CRP, the score of PSI and were not significantly different(P>0. 05)in systolic pressure,diastolic pressure,TNI and PCO2. (3) Group A was significantly different(P<0. 05)in NT-proBNP from group C and group D,group B was significantly different (P<0. 05)in NT-proBNP from group C and group D,and group C was significantly different(P<0. 05)in NT-proBNP from group D. (4) The Spearman correlation analysis showed that NT-proBNP was positively correlated with TNI( rs =0. 21, P<0. 05),PCT(rs =0. 30,P<0. 05),WBC(rs =0. 15,P<0. 05),NEUT(rs =0. 25,P<0. 05),ESR(rs =0. 23, P<0. 05),CRP(rs =0. 40,P<0. 05)and PSI(rs =0. 54,P<0. 05). With PCT>0. 25 μg/L as the cutoff point,the Spearman correlation analysis was further conducted,and the results showed that NT-proBNP was positively correlated with PCT in patients with bacterial infection(rs =0. 40,P=0. 00). Conclusion The exacerbation of bacterial infection could lead to the increase of NT-proBNP level in patients, which may be mediated by bacterial endotoxin through inflammatory medium. NT-proBNP can be used as an indicator of disease severity degree and prognosis of CAP patients.