CAJ | 학술논문

目的：本研究通过观察重症肺炎致急性呼吸窘迫综合征（ARDS）患者血N末端B型钠尿肽前体（NT‐proBNP）、肌钙蛋白I（cTnI）水平及其与C‐反应蛋白（CRP）之间的关系，从而进一步深入探讨ARDS ，尤其是ARDS后继发心肌损伤的病理生理过程及临床意义。方法将确诊为重症肺炎致ARDS的患者33例分为轻度、中度、重度3组，收集患者入院时血气分析、CRP、NT‐proBNP、cTnI等相关指标数据，并进行统计学分析。结果重度组NT‐proBNP水平明显高于轻、中度组（P＜0．01），中度组NT‐proBNP水平也较轻度组升高（P＜0．05）；重度组cTnI水平与轻、中度组比较明显增高（P＜0．01），而轻、中度组间比较差异无统计学意义（P＞0．05）；3组间CRP水平也有随着病情加重而逐渐升高，重度组CRP水平显著高于轻度组（P＜0．05）；ARDS患者血NT‐proBNP水平与CRP水平呈显著正相关（P＜0．05），且与cTnI水平呈正相关关系（P＜0．05）。结论 ARDS病程中过度活化的炎性反应很可能直接参与并介导心肌损伤的病理生理过程；联合NT‐proBNP、cTnI检测对ARDS病程早期评价，及早期实施器官功能保护有着重要临床意义。
목적：본연구통과관찰중증폐염치급성호흡군박종합정（ARDS）환자혈N말단B형납뇨태전체（NT‐proBNP）、기개단백I（cTnI）수평급기여C‐반응단백（CRP）지간적관계，종이진일보심입탐토ARDS ，우기시ARDS후계발심기손상적병리생리과정급림상의의。방법장학진위중증폐염치ARDS적환자33례분위경도、중도、중도3조，수집환자입원시혈기분석、CRP、NT‐proBNP、cTnI등상관지표수거，병진행통계학분석。결과중도조NT‐proBNP수평명현고우경、중도조（P＜0．01），중도조NT‐proBNP수평야교경도조승고（P＜0．05）；중도조cTnI수평여경、중도조비교명현증고（P＜0．01），이경、중도조간비교차이무통계학의의（P＞0．05）；3조간CRP수평야유수착병정가중이축점승고，중도조CRP수평현저고우경도조（P＜0．05）；ARDS환자혈NT‐proBNP수평여CRP수평정현저정상관（P＜0．05），차여cTnI수평정정상관관계（P＜0．05）。결론 ARDS병정중과도활화적염성반응흔가능직접삼여병개도심기손상적병리생리과정；연합NT‐proBNP、cTnI검측대ARDS병정조기평개，급조기실시기관공능보호유착중요림상의의。
Objective To investigate the association betweent clinical markers of N‐terminal probrain natriuretie peptide (NT‐proBNP) ,cardiac troponin I (cTnI) and C‐reaction protein (CRP) in the patients with acute respiratory distress syndrome (ARDS) caused by severe pneumonia and to reveal the pathophysiologic process of myocardial injury after ARDS .Methods Totally 33 patients diagnosed as ARDS caused by severe pneumonia were divided into 3 groups:mild group ,moderate group and severe group according to the New Berlin definition of ARDS .Arterial blood gas analysis ,NT‐proBNP ,cTnI and CRP were observed be‐fore the treatment .Statistics were used for the analyses .Results The NT‐proBNP level in the severe group was significantly higher than that in the mild and moderate groups (P<0 .01);the NT‐proBNP level in the moderate group was also higher than that in the mild group (P< 0 .05) .Besides ,the cTnI level in the severe group was significantly higher than that in the mild and moderate groups (P<0 .01);however ,the cTnI level had no statistical difference between mild and moderate groups (P> 0 .05) .The CRP level in the severe group was significantly higher than that in the mild (P<0 .05) .Moreover ,the NT‐proBNP level of 33 patients was positively associated with the both CRP and cTnI level (P<0 .05) .Conclusion The seriously inflammatory response mediates myocardial injury probably because of ARDS .Combined NT‐proBNP and cTnI testing is important for evaluating the condition of ARDS at the early stage .