血浆N末端脑钠肽前体对老年慢性阻塞性肺疾病预后的评估作用  

Prognostic role of NT-proBNP in elderly patients with chronic obstructive pulmonary disease

作　　者：宋雨[1] 杨伟[1] 王洁妤[1] 钱玉英[1] 李耘[1] 

机构地区：[1]首都医科大学宣武医院综合科,北京100053

出　　处：《疑难病杂志》2018年第1期1-4,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：北京市保健科研课题(京13-01)

摘　　要：目的探讨N末端脑钠肽前体(NT-proBNP)对老年慢性阻塞性肺疾病(慢阻肺)患者预后的评估作用。方法选择2015年1月—2016年2月于首都医科大学宣武医院综合科住院的慢阻肺患者236例作为研究对象,收集患者一般情况、血气分析指标、肺功能指标及NT-proBNP水平等临床资料。并对出院患者进行1年随访,终点事件为因严重急性加重再入院及死亡。分析NT-proBNP对慢阻肺患者预后的评估作用。结果多因素Cox回归分析显示NT-proBNP是老年慢阻肺患者病情平稳后1年内因严重急性加重再入院或死亡的独立危险因素(HR 1.001,95%CI 1.000~1.001)。经ROC曲线分析,以NT-proBNP=170.5 pg/ml为截断值预测患者严重急性加重、以NTproBNP=286.7 pg/ml为预测全因死亡具有较高敏感度及特异度。Kaplan-Meier生存分析显示NT-proBNP≥170.5 pg/ml的患者严重急性加重风险明显升高,而NT-proBNP≥286.7 pg/ml的患者死亡风险明显升高。结论 NT-proBNP为老年慢阻肺患者严重急性加重或死亡的独立危险因素,可以用于评估患者不良预后。Objective To study the prognostic role of NT-proBNP in elderly patients with chronic obstructive pulmonary disease（COPD）. Methods Two hundred and thirty-six patients were recruited in the study,all the＇patients were older than 65 years old and in stable COPD. Research data included general conditions,arterial blood gas analysis,pulmonary function and NT-proBNP. One year follow up started after discharged, and the endpoints were severe acute exacerbation and death. Statistics methods were used to evaluate the predictive value of NT-proBNP for the prognosis. Results Multivariate Cox regression analysis showed that NT-proBNP was an independent risk factor for severe acute exacerbation or death after one year of discharge （HR 1. 001,95% CI 1. 000 -1. 001 ）. The best cut-off value to predict acute exacerbation or death of NT-proBNP was 170.5 pg/ml and 286.7 pg/ml, which was calculated by receiver operating characteristic curve （ ROC ）. Kaplan-Meier analysis showed that the risk of severe acute exacerbation was significantly higher in group of NT-proBNP ≥ 170.5 pg/ml, and the survival rate of NT-proBNP 〈 286.7pg/ml group was significantly better than NT-proBNP≥286.7 pg/ml group. Conclusion High levels of NT-proBNP significantly correlate with poor prognosis of elderly patients with COPD. NT-proBNP is an independent risk factor for severe acute exacerbation and death.

关 键 词：慢性阻塞性肺疾病 N末端脑钠肽前体 预后 老年人 

分 类 号：R563.9[医药卫生—呼吸系统]