血浆N-末端脑钠肽前体片段对外科危重患者预后的预测价值  

Predictive value of serum NT - pro - BNP for the prognosis in surgical critically ill patients

作　　者：甄根深[1] 李文雄[2] 赵松[2] 郑悦[2] 隋峰[2] 张贵辰[2] 刘薇[2] 

机构地区：[1]首都医科大学潞河教学医院ICU,北京101149 [2]首都医科大学附属北京朝阳医院SICU

出　　处：《中国急救医学》2010年第11期970-973,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 评价血浆N-末端脑钠肽前体片段（NT-proBNP）对外科危重患者预后的预测价值.方法 选择我院外科重症监护病房（SICU）在2009-01~2009-12期间连续收治、住SICU时间≥5 d的外科成年患者为研究对象,所有患者在入SICU后的第1、3、5天检测血浆NT-proBNP浓度,随访患者入SICU后30 d的生存状况,并根据以上数据构建接受者操作特征曲线,分析第1、3、5天血浆NT-proBNP对预后的预测价值.结果 65例患者中,55例存活,10例死亡.两组第1、3天血浆NT-proBNP浓度比较差异无统计学意义（P均＞0.05）,死亡组第5天血浆NT-proBNP浓度显著高于存活组（P＜0.05）.第1、3、5天血浆NT-proBNP浓度预测患者入SICU后30 d内死亡的曲线下面积分别为0.63、0.68和0.76 第5天血浆NT-proBNP浓度超过1919 ng/mL时,预测患者入SICU后30 d内死亡的敏感度为90.0%,特异度为65.5%.结论 外科危重患者在入SICU第5天的血浆NT-proBNP浓度对预后具有较好的预测价值,血浆NT-proBNP浓度超过1919 ng/mL者预后不良.Objective To evaluate the predictive value of serum N - terminal pro - brain natriuretic peptide （ NT - pro - BNP） for the prognosis in surgical critically ill patients. Methods To select prospectively patients admitted to Surgical Intensive Care Unit （SICU） at least five days in a teaching hospital affiliated to Capital Medical University. Serum NT - pro - BNP was detected on 1, 3 and 5 day after the patients were admitted to SICU. The 30 - day mortality of all the patients was followed since SICU admission. The receiver operating characteristics （ROC） curves were constructed according to data of serum NT - pro - BNP levels and 30 - day mortality, and the predictive value of serum NT - pro - BNP for prognosis on 1, 3 and 5 day was analyzed. Results 55 of 65 cases survived and other 10 cases died within 30 days after SICU admission. There was no significant difference in serum NT - pro - BNP on 1 and 3 day between the survivor group and the non - survivor group （ P 〉 0. 05 ）. Serum NT - pro - BNP level was significantly higher in the non - survivor group compared with the survivor group （ P 〈 0.05 ）. The area under the curve on 1, 3 and 5 day was 0.63, 0.68 and 0.76 correspondingly. The sensitivity and specificity of predicting 30 - day mortality with NT - pro - BNP levels more than 1919 ng/mL on 5 day was 90% and 65.5%. Conclusion NT - pro - BNP level on 5 day after SICU admission had better predictive value for the prognosis among critically ill patients. The patients with NT - pro - BNP more than 1919 pg/mL on 5 day had bad prognosis.

关 键 词：脑钠肽 预后 外科 重症监护病房 

分 类 号：R541.6[医药卫生—心血管疾病]