BNP、PCT水平对老年社区获得性肺炎合并心力衰竭患者病情及近期预后的影响  

The influences of BNP and PCT on the disease condition and short-term prognosis of community acquired pneumonia patients combined with heart failure

作　　者：吴月红 鞠阳 边缓缓 柴晓燕 刘晓宁 王亚静 李花叶 WU Yuehong;JU Yang;BIAN Huanhuan(Department of Emergency,Shijiazhuang Fifth Hospital,Hebei,Shijiazhuang 050021,China;不详)

机构地区：[1]河北省石家庄市第五医院急诊科,050021 [2]华北医疗健康集团峰峰总医院邯郸院区内科 [3]河北省石家庄市医保中心

出　　处：《河北医药》2023年第20期3066-3070,共5页Hebei Medical Journal

基　　金：河北省卫生健康委员会医学科学研究重点课题(编号:20191457)。

摘　　要：目的探讨老年社区获得性肺炎(community acquired pneumonia,CAP)合并心力衰竭(HF)患者入院时氨基末端脑钠肽前体(N-terminal pro-B type natriuretic peptide,NT-proBNP)、血清降钙素原(Procalcitonin,PCT)水平对病情严重程度的评估及近期预后的影响。方法回顾性分析2017年10月至2019年10月就诊的216例老年社区获得性肺炎合并心衰患者资料,以30 d内死亡或出院为终点事件,分为治愈组和死亡组,收集所有患者入院时血清BNP、PCT及C-反应蛋白(C-reactive protein,CRP)等生化指标;评估并记录所有患者入院时肺炎严重指数(Pneumonia Severity Index,PSI)评分以及心脏超声结果。结果与治愈组比较,死亡组LVEF显著降低(P<0.05);PSI评分、LVEDD、LVESD则明显增高(P<0.05)。尽管治愈组血清BNP、PCT及CRP水平明显低于死亡组(P<0.05),但通过受试者工作特征(ROC)曲线,发现PSI评分以及CRP水平可以作为评判老年CAP合并HF患者病情及近期预后的重要因素,而不是BNP、PCT水平。单因素方差分析治愈组PSI评分、CRP与死亡组存在差异(P<0.05),BNP、PCT水平无差异(P>0.05)。结论通过检测入院时血清BNP、PCT水平,未能发现这两种生物标记物对于评估社区获得性肺炎合并心衰患者病情严重程度及预后预测具有明显的价值。Objective To investigate the effects of serum N-terminal pro-B type natriuretic peptide(NT-proBNP)and procalcitonin(PCT)levels on the severity and short-term prognosis of community acquired pneumonia(CAP)patients combined with heart failure(HF).Methods The data of 216 CAP patients combined with HF treated in our hospital from October 2017 to October 2019 were retrospectively analyzed.Taking death or discharge within 30 days as the end point,they were divided into cure group and death group.The biochemical indexes such as serum NT-proBNP,PCT and C-reactive protein(CRP)were collected.The pneumonia severity index(PSI)score and cardiac ultrasound results at admission were evaluated and recorded.Results Compared with those of the cured group,the left ventricular ejection fraction(LVEF)in the dead group decreased significantly(P<0.05),while the PSI,left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)increased significantly(P<0.05).Although serum NT-proBNP,PCT and CRP in the cure group were significantly lower than those in the death group(P<0.05),only PSI and CRP could be used to predict the severity and short-term prognosis of CAP patients combined with HF by the receiver operating characteristic(ROC)curve,rather NT-proBNP and PCT.One-way ANOVA data showed that there were significant differences in PSI and CRP between the cure group and the death group(P<0.05),but there were no significant differences in NT-proBNP and PCT levels(P>0.05).Conclusion The detection of serum NT-proBNP and PCT levels at admission has a uncertain value in evaluating the severity and prognosis of CAP patients combined with HF.

关 键 词：氨基末端脑钠肽前体 降钙素原 老年 社区获得性肺炎 心衰 

分 类 号：R563.1[医药卫生—呼吸系统]