B型利钠肽、白细胞介素6及APACHEⅡ评分对老年重症肺炎合并心力衰竭患者预后的评估价值  

Prognostic value of B-type natriuretic peptide,interleukin-6 and APACHEⅡscore in elderly patients with severe pneumonia complicated with heart failure

作　　者：苗利辉 李京[2] 王明虎[3] 岑强 Lihui Miao;Jing Li;Minghu Wang;Qiang Cen(Department of Geriatric Rehabilitation Center,Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China;Department of Emergency,Fu Xing Hospital,Capital Medical University,Beijing 100038,China;Emergency Medical Center,Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China;Department of Cardiology,Fu Xing Hospital,Capital Medical University,Beijing 100038,China.)

机构地区：[1]首都医科大学附属北京康复医院老年康复中心,北京100144 [2]首都医科大学附属复兴医院急诊科,北京100038 [3]首都医科大学附属北京康复医院急救医学中心,北京100144 [4]首都医科大学附属复兴医院心内科,北京100038

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2023年第1期11-16,共6页Chinese Journal of Heart Failure and Cardiomyopathy

摘　　要：目的探讨老年重症肺炎合并心力衰竭患者血浆B型利钠肽(BNP)、白细胞介素6(IL-6)及急性生理和慢性健康状况(APACHEⅡ)评分对预后的评估价值。方法回顾性分析首都医科大学附属复兴医院急诊留观室及急诊监护室2020年1月至2022年6月期间共124例年龄≥60岁老年重症肺炎合并心力衰竭患者资料。根据患者28天转归,分为死亡组(n=39)和存活组(n=85),比较两组患者基线人口学特征、超声心动图指标,以及入院后24h实验室化验、APACHEⅡ评分结果的差异,应用多因素logistic回归分析探究影响老年重症肺炎合并心力衰竭患者不良预后的危险因素,并进行受试者工作特征(ROC)曲线分析入院24h的BNP、IL-6及APACHEⅡ评分对老年重症肺炎合并心力衰竭患者预后的评估价值。结果死亡组患者基线年龄、谷丙转氨酶、C反应蛋白、降钙素原、IL-6、BNP及APACHEⅡ评分均显著高于对照组(P均<0.05),收缩压及左心室射血分数显著低于对照组(P<0.05)。多因素logistic回归分析显示,入院24h内BNP、IL-6、APACHEⅡ评分是老年重症肺炎合并心力衰竭患者不良预后的独立危险因素。患者入院24h内BNP、IL-6、APACHEⅡ评分的ROC曲线下面积分别为0.814(敏感度76.9%、特异度78.8%)、0.875(敏感度74.4%、特异度89.4%)和0.917(敏感度100%、特异度71.8%)。结论患者入院24h内血清BNP、IL-6及APACHEⅡ评分对老年重症肺炎合并心力衰竭患者的短期预后具有预测价值。Objective To investigate the prognostic value of B-type natriuretic peptide(BNP)、interleukin-6(IL-6)and Acute Physiology And Chronic Health EvaluationⅡ(APACHEⅡ)scores in elderly patients with severe pneumonia complicated with heart failure.Methods A total of 124 elderly patients of ages≥60 years with severe pneumonia complicated with heart failure admitted to the Department of Emergency in Fu Xing Hospital Affiliated to the Capital University from January 2020 to June 2022 were retrospectively analyzed.According to their clinical outcomes within 28 days,they were divided into the death group(n=39)and survivor group(n=85).The differences in baseline demographic characteristics,echocardiography,and laboratory tests,APACHEⅡscores within 24 hours after admission were compared between the two groups.Multivariate logistic regression analysis was used to explore the risk factors affecting the poor prognosis of elderly patients with severe pneumonia complicated with heart failure.The receiver-operating characteristic curve(ROC)was used to analyze the prognostic value of BNP,IL-6 and APACHEⅡscore within 24 hours after admission.Results There were significantly higher age,alanine aminotransferase,C-reactive protein,procalcitonin,IL-6,BNP,and APACHEⅡscore in the death group than those in the survivor group(all P<0.05),as well as lower systolic blood pressure and left ventricular ejection fraction in the death group than that in the survivor group(both P<0.05).Multivariate logistic regression analysis showed that BNP,IL-6,and APACHEⅡscore within 24 hours of admission were independent risk factors for poor prognosis in elderly patients with severe pneumonia and heart failure.The areas under the ROC(AUC)of BNP,IL-6,and APACHEⅡscore within 24h after admission were 0.814(sensitivity 76.9%,specificity 78.8%),0.875(sensitivity 74.4%,specificity 89.4%)and 0.917(sensitivity 100%,specificity 71.8%).Conclusion The serum BNP,IL-6,and APACHEⅡscore within 24 hours after admission may have prognostic value in elderly p

关 键 词：心力衰竭 重症肺炎 老年 预后 

分 类 号：R563.1[医药卫生—呼吸系统] R541.6[医药卫生—内科学]