B型利钠肽在预测重症患者急性肾损伤发生发展中的临床价值  

Clinical value of B-type natriuretic peptide in predicting the occurrence and development of acute kidney injury in critically ill patients

作　　者：陈敏华[1] 朱峥 金君 孙仁华[1] 陈健良[2] Chen Minhua;Zhu Zheng;Jin Jun;Sun Renhua;Chen Jianliang(Emergency and Critical Care Center,Intensive Care Unit,Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College),Hangzhou 310014,China;Intensive Care Unit,Pan'an People's Hospital of Zhejiang Province(Pan'an Branch of Jinhua Municipal Central Hospital),Jinhua 322399,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)急诊重症中心重症医学科,杭州310014 [2]浙江省磐安县人民医院(金华市中心医院磐安分院)重症医学科,浙江金华322399

出　　处：《中华危重症医学杂志（电子版）》2022年第4期279-284,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省科技厅公益项目(LGF22H150018);浙江省医药卫生科技计划项目(2018KY269,2021KY481)。

摘　　要：目的探讨重症患者B型利钠肽(BNP)水平在急性肾损伤(AKI)发生发展中的临床价值。方法回顾性分析2019年10月至2021年9月浙江省人民医院ICU收治的591例患者的病历资料,根据患者住ICU期间有无出现AKI将其分为AKI组(345例)和无AKI组(246例),并根据AKI严重程度将其进一步分为无AKI组(246例)、AKI-1级组(71例)、AKI-2级组(63例)和AKI-3级组(211例)。比较所有患者的临床资料,同时采用多因素Logistic回归分析筛选影响重症患者发生AKI的独立危险因素。结果AKI组和无AKI组患者脓毒症(χ^(2)=6.326,P=0.012)、急性病生理学和长期健康评价Ⅱ评分(t=2.393,P=0.017)、序贯器官衰竭估计评分(t=3.146,P=0.002)、住院时间(Z=3.413,P=0.001)、28 d病死率(χ^(2)=29.138,P<0.001)、住院病死率(χ^(2)=34.265,P<0.001)、白蛋白(t=2.213,P=0.027)、血乳酸(t=2.049,P=0.037)、入ICU第1天BNP(BNP-1)(Z=4.285,P<0.001)、入ICU第3天BNP(BNP-3)(Z=6.717,P<0.001)、BNP上升率(Z=4.319,P<0.001)、尿素氮(Z=3.231,P<0.001)和血清肌酐(Z=4.560,P<0.001)比较,差异均有统计学意义。无AKI组、AKI-1级组、AKI-2级组和AKI-3级组BNP-1、BNP-3及BNP上升率比较,差异均有统计学意义(H=11.468、29.302、18.366,P均<0.05),且AKI-3级组患者BNP-3水平较无AKI组、AKI-1级组和AKI-2级组更高(P均<0.05)。多因素Logistic回归分析结果显示,BNP-3水平[比值比(OR)=1.000,95%置信区间(CI)(1.000,1.001),P=0.026]和血清肌酐[OR=1.002,95%CI(1.000,1.003),P=0.019]为影响重症患者发生AKI的独立危险因素。结论重症患者的BNP水平,尤其是入ICU第3天时的BNP水平,与是否发生AKI及严重程度显著相关。BNP在预测AKI的发生发展中具有一定的临床应用价值。Objective To explore the clinical value of B-type natriuretie peptide(BNP)in predicting the occurrence and development of acute kidney injury(AKI)in critically ill patients.Methods A retrospective analysis was performed on 591 patients who were admitted to the ICU of Zhejiang Provincial People's Hospital from October 2019 to September 2021.The patients were grouped into the AKI group(345 cases)and AKI-free group(246 cases)according to the presence or absence of AKI during the ICU stay.According to the severity of AKI,they were further grouped into the AKI-free group(246 cases),AKI-class 1 group(71 cases),AKI-class 2 group(63 cases)and AKI-class 3 group(211 cases).The clinical data of all patients were compared,and multivariate Logistic regression analysis was used to screen independent risk factors for AKI in severe patients.Results The differences of sepsis(χ^(2)=6.326,P=0.012),acute physiology and chronic health evaluationⅡscore(t=2.393,P=0.017),sequential organ failure assessment score(t=3.146,P=0.002),hospitalization time(Z=3.413,P=0.001),28-day mortality(χ^(2)=29.138,P<0.001),in-hospital mortality(χ^(2)=34.265,P<0.001),albumin(t=2.213,P=0.027),lactate(t=2.049,P=0.037),BNP on the first day of ICU admission(BNP-1)(Z=4.285,P<0.001),BNP on the third day of ICU admission(BNP-3)(Z=6.717,P<0.001),BNP rise rate(Z=4.319,P<0.001),urea nitrogen(Z=3.231,P<0.001)and serum creatinine(Z=4.560,P<0.001)were all statistically significant between the AKI group and AKI-free group.There were also significant differences in the BNP-1,BNP-3 and BNP rise rate among the AKI-free group,AKI-class 1 group,AKI-class 2 group and AKI-class 3 group(H=11.468,29.302,18.366;all P<0.05),and the BNP-3 level of AKI-class 3 group was higher than that of AKI-free group,AKI-class 1 group and AKI-class 2 group(all P<0.05).In addition,multivariate Logistic regression analysis showed that the BNP-3 level[odds ratio(OR)=1.000,95%confidence interval(CI)(1.000,1.001),P=0.026]and serum creatinine level[OR=1.002,95%CI(1.000,1.003),P=0.019]were indepen

关 键 词：重症患者 急性肾损伤 B型利钠肽 预测 临床价值 

分 类 号：R692[医药卫生—泌尿科学]