B型钠尿肽评估肿瘤重症患者预后的临床价值研究  

Clinical significance of B-type natriuretic peptide in predicting outcomes of critically ill cancer patients

作　　者：沈珏[1] 顾葆春[1] 苏磊[2] 赵擎宇[1] 

机构地区：[1]华南肿瘤学国家重点实验室,中山大学肿瘤防治中心重症医学科,广东广州510060 [2]广州军区广州总医院重症医学科,广东广州510010

出　　处：《中国中西医结合急救杂志》2013年第2期79-82,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：卫生部医卫科研发展中心科研项目（WH2011-01-02）;

摘　　要：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人重症监护病房（mU）24h内的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOVA）、血浆BNP水平；以28d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APACHE11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、APACHEⅡ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）mmHg，1mmHg=0．133kPa]、血红蛋白[Hb：（110．5±23．2）g/L]明显高于死亡组[（74．2±34．1）mmHg、（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（nOC曲线）下面积（AUC）发现，在区分患者死亡与存活能力方面，BNP与APACHEⅡ、SOFA评分系统差异均无统计学意义（r1=3．42，P．=0．064；r2=3．20，P2：0．076）。Cox比例风险回归分析表明，APACHEⅡ评分和SOFA评分是预测患者28d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�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〈0.053. 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〈 0.053. From the comparisons between the are

关 键 词：B型钠尿肽 重症 肿瘤患者 预后 

分 类 号：R197.322[医药卫生—卫生事业管理]