N-末端B-型钠尿肽前体在ICU非心源性重症患者预后判断中的应用价值  

Prognosis assessment value of N-terminal pro-B-type natriuretic peptide for noncardiac severe patients in intensive care unit

作　　者：李宝亮[1] 苏华[1] 陈琛[2] 

机构地区：[1]河北北方学院附属第一医院检验科,河北省张家口市075000 [2]河北北方学院附属第一医院ICU,河北省张家口市075000

出　　处：《河北医药》2015年第3期343-345,共3页Hebei Medical Journal

摘　　要：目的探讨氨基末端B型钠尿肽前体(NT-pro-BNP)是否是ICU非心源性重症患者预后判断的独立危险因素。方法采用前瞻性研究方法,选择综合ICU非心源性患者152例,进入ICU后完善患者基本资料,记录患者年龄、性别、APACHEⅡ评分等。于收治1、2、5 d进行NT-pro BNP检测,记录患者28 d的终点事件。结果 152例入选患者28 d死亡率40.13%(61/152)。死亡组血浆NT-pro-BNP第1天浓度和APACHEⅡ评分明显高于存活组(P<0.05),NT-pro-BNP与APACHEⅡ有相关性,且均为影响患者28 d死亡率的独立危险因素,二者的敏感性、特异性ROC曲线比较,NT-pro-BNP ROC曲线下面积为0.731,APACHEⅡ评分ROC曲线下面积为0.716,在评估患者预后比较中NT-pro-BNP优于APACHEⅡ,但差异无统计学意义(P>0.05)。血浆NT-pro-BNP最佳临界值为5 003.39 pg/ml,NT-pro-BNP<5 003 pg/ml组生存率高于NT-pro-BNP>5 003 pg/ml组(χ2=32.1,P<0.01)。结论ICU非心源性重症患者NT-pro-BNP>5 003 pg/ml是判断预后的独立危险因素。Objective To investigate whether plasma N-terminal pro-B-type natriuretic peptide （NT-pro-BNP） is an independent risk factor for noncardiac severe patients in intensive care unit （ ICU ） .Methods A prospective observational study was performed in which 152 noncardiac severe patients in ICU were enrolled .The patients ’ age, sex, basic data, APACHEⅡscores were collected,the patients’ NT-pro-BNP levels were detected at day 1,2,5 after admission to ICU and 28-day mortality was recorded.Results The 28-day mortality of the patients was 39.8%（61/152）.The plasma NT-pro-BNP levels （pg/ml） and APACHE Ⅱscore in death group were significantly higher than those in survival group （ P 〈0.05） at the first day of admission to ICU.There was a correlation between plasma NT-pro-BNP levels and APACHE II score,moreover, which was independent risk factor of influencing 28-day mortality of noncardiac severe patients in ICU .The area under receiver operating characteristic curve （ ROC curve） of NT-pro-BNP and APACHE Ⅱ score were 0.731 and 0.714,respectively. NT-pro-BNP was better than APACHE Ⅱ in evaluating patients ’ prognosis , however , there was no significant difference between them （ P 〉0.05）.The optimized critical value of plasma NT-pro-BNP was 5 003.39pg/ml,furthermore,the survival rate in NT-pro-BNP〈5 003pg/ml group was significantly higher than that NT-proB-NP〉5 003pg/ml group （χ2=32.1, P〈0.01）.Conclusion The NT-pro-BNP〉5 003pg/ml of noncardiac severe patients in ICU is an independent risk factor in evaluating patients’ prognosis.

关 键 词：N-末端B型钠尿肽前体 APACHEⅡ评分 ICU 非心源性重症患者 预后评估 

分 类 号：R446.112[医药卫生—诊断学]