B型钠尿肽预测社区获得性肺炎严重程度的意义  

The roles of using B-type natriuretic peptide to predict the severity of community-acquired pneumonia

作　　者：李京[1] 叶寰[2] 赵丽[1] 

机构地区：[1]首都医科大学附属复兴医院急诊科,北京100038 [2]首都医科大学附属复兴医院感染科,北京100038

出　　处：《中华急诊医学杂志》2014年第10期1132-1137,共6页Chinese Journal of Emergency Medicine

基　　金：北京市西城区优秀人才培养专项经费资助个人项目（20110046）

摘　　要：目的 通过对社区获得性肺炎（community-acquired pneumonia,CAP）患者BNP（B型钠尿肽）与肺炎严重程度之间相关性的研究,评估BNP预测CAP严重程度的意义.方法 2011年12月至2012年12月就诊我科并确诊CAP患者202例,测定BNP、C-反应蛋白（CRP）、白细胞计数（WBC）,以及肺炎严重度评分（PSI）所需相关指标,计算PSI评分并分级.分析不同肺炎严重程度分级之间BNP水平、C-反应蛋白、白细胞计数的差异,以及BNP与PSI的相关性.进一步根据PSI水平分为高风险组（PSI分级Ⅳ、Ⅴ级）和低风险组（PSI分级Ⅰ～Ⅲ级）;根据患者预后分为存活组和死亡组.比较两组间BNP差异、BNP水平与肺炎严重程度的受试者工作特征（ROC）曲线.结果 BNP水平随着CAP严重程度增加而升高（r =0.782,P＜0.001）;高风险组患者BNP水平显著高于低风险阻[（263.2±119.6）pg/mLvs.（71.5±54.3） pg/mL,P＜0.001].相比存活组,死亡组BNP水平更高[（343.86±125.49）vs.（183.00±121.71） pg/mL,P＜0.001].BNP与PSI评分、CRP以及WBC呈正相关（r=0.782,P＜0.001,r=0.560,P＜0.001和r=0.513,P＜0.001）.BNP对于CAP严重程度的预测有较高的准确性（AUC =0.952）,区分高、低风险的BNP最佳截点为125.0 pg/mL,敏感性0.891,特异性0.946.BNP能预测死亡（AUC =0.823）,其预测死亡最佳截点为299.0 pg/mL,敏感性0.675,特异性0.816,阴性预测值0.926,阳性预测值0.426.结论 BNP与CAP严重程度呈正相关关系,BNP大于125.0 pg/mL的CAP患者建议住院治疗,BNP大于299.0 pg/mL的CAP患者具有死亡高风险.BNP预测CAP严重程度具有一定实用性.Objective To evaluate the roles of B-type natriuretic peptide （BNP） in predicting the severity of community-acquired pneumonia （CAP） by studying the correlation between them.Methods A total of 202 patients with CAP admitted from December 2011 to December 2012 were enrolled in this study.All these patients were checked with laboratory tests for BNP level,C-reactive protein （CRP）,white blood cell count （WBC） as well as other markers needed for obtaining pneumonia severity index （PSI）.The differences in BNP levels,CRP levels,and WBC were compared among different degrees of pneumonia severity,and the correlation between BNP levels and PSI was investigated by a linear correlation analysis.The patients enrolled were divided into a high-risk group （defined as Ⅳ-Ⅴ grade of PSI） and a low-risk group （defined as Ⅰ-Ⅲgrade of PSI）.Meanwhile,they were also divided into a survivor group and a non-survivor group according to outcomes.BNP levels between the two groups were compared,and a receiver operating characteristic （ROC） curve analysis was performed on the BNP levels versus PSI.Results BNP levels increased with CAP severity （r =0.782,P ＜0.01）.The mean level of BNP （263.2 ± 119.6） pg/mLof patients in the high-risk group was significantly higher than that of patients （71.5 ± 54.3） pg/mL in the low-risk group （P ＜ 0.01）.The patients in the non-survivor group had significantly higher BNP levels compared to the survivor group [（343.86 ± 125.49） vs.（183.00 ±121.71） pg/mL,P ＜ 0.01].In addition,there were positive correlations between BNP levels and PSI （r =0.782,P＜0.001）,between BNP levels and CRP levels （r =0.560,P＜0.01）,and between BNP levels and WBC （r =0.513,P＜0.001）.The BNP level had a high accuracy in predicting the severity of CAP （AUC =0.952）.The optimal cut-off point of BNP level for distinguishing high-risk from low-risk patients was 125.0 pg/mL,with a semitivity of 0.891 and a specificity of 0.946.Moreover,BNP level had a de

关 键 词：社区获得性肺炎 B型钠尿肽 肺炎严重度评分 生物学指标 急诊 病情评估 促炎细胞因子 炎症反应 

分 类 号：R563.1[医药卫生—呼吸系统]