和肽素联合N末端脑钠肽前体对急危重症患者30天死亡的预测价值  

Predictive value of copeptin combined with N-terminal pro-brain natriuretic peptide in 30-day mortality of critically ill patients

作　　者：郑亮亮[1] 王凡[1] 张新超[1] 温伟[1] Zheng Liangliang;Wang Fan;Zhang Xinchao;Wen Wei(Emergency Department,National Center of Gerontology,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京医院国家老年医学中心急诊科,北京100730

出　　处：《中国急救医学》2023年第7期532-537,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的分析血清和肽素(copeptin)联合N末端脑钠肽前体(NT-proBNP)对急危重症患者30 d死亡的预测价值。方法选择北京医院急诊科2017年3月至2019年2月入住急诊抢救室或重症监护室的患者201例作为研究对象,来诊时立即留取血清标本测定和肽素、NT-proBNP水平及其他常用临床血液指标,所有病例均随访30 d,记录患者生存情况。临床资料采用SPSS 25.0软件进行统计处理。结果血清和肽素水平在30 d随访死亡组与生存组之间差异有统计学意义(32.350 pg/mL vs.12.378 pg/mL)。经独立危险因素Logistic二元回归模型分析,血清和肽素、ln(NT-proBNP)对急危重症患者的预后有独立预测意义(OR值分别为1.069、1.768)。ROC曲线分析提示,和肽素、NT-proBNP的AUC分别为0.762、0.703,二者联合预测ROC曲线AUC为0.840,优于单一指标AUC。进一步分析发现,两者均呈高水平的患者较之低水平患者病死率明显增高。结论血清和肽素及NT-proBNP均可作为急危重症患者30 d死亡风险的独立预测因子,对急危重症患者的预后有较好的辅助预测价值,且两指标联合相较于单一指标预测预后价值更大。Objective To analyze the predictive value of copeptin combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)in 30-day in-hospital mortality of critically ill patients.Methods 201 patients from resuscitation room or intensive care unit of emergency department in Beijing hospital from March 2017 to February 2019 were involved in this research.Serum specimens were immediately taken to determine copeptin,NT-proBNP and other clinical indexes of blood examination.All the patients’30 d prognosis was followed up.SPSS 25.0 was used for statistical processing of clinical data.Results Serum copeptin level was significantly higher in the death group than in the survival group at 30-day follow-up(32.350 pg/mL vs.12.378 pg/mL).According to Logistic binary regression model of the independent risk factors,serum copeptin and ln(NT-proBNP)had independent predictive significance for the prognosis of critically ill patients(OR value was 1.069,1.768,respectively).The ROC curve analysis showed that the AUC of copeptin and NT-proBNP were 0.762 and 0.703 respectively,and the AUC of combined ROC curve was 0.840,which was better than the AUC of a single indicator.Further analysis showed that patients with higher levels of both had significantly higher mortality rates than those with lower levels.Conclusion Either serum copeptin or NT-proBNP levels can be used as an independent predictor of 30-day prognosis and has a good auxiliary evaluation value in acute critical illness patients,and greater predictive value was observed in the combination of two indicators compared with a single indicator.

关 键 词：和肽素(copeptin) N末端脑钠肽前体(NT-proBNP) 危重症 30天死亡 

分 类 号：R459.7[医药卫生—急诊医学]