老年营养风险指数联合血清NT-proBNP水平对老年慢性心力衰竭合并社区获得性肺炎患者预后的评估价值  

Prognostic value of elderly nutritional risk index combined with serum NT-proBNP levels in elderly patients with chronic heart failure combined with community-acquired pneumonia

作　　者：冯辽辽 闫竹梅 李霞霞 Feng Liaoliao;Yan Zhumei;Li Xiaxia(Department of infectious diseases,Yulin Traditional Chinese Medicine Hospital,Yulin,Shaanxi 719000,China;不详)

机构地区：[1]榆林市中医医院感染性疾病科,榆林719000 [2]榆林市中医医院老年病科,榆林719000 [3]榆林市中医医院急诊科,榆林719000

出　　处：《中国循证心血管医学杂志》2024年第11期1318-1322,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：陕西省卫健委科研项目(2020D0012)。

摘　　要：目的探讨老年营养风险指数(GNRI)联合血清N末端脑钠肽前体(NT-proBNP)水平对老年慢性心力衰竭(CHF)合并社区获得性肺炎(CAP)患者预后的评估价值。方法选取2021年1月至2023年5月于榆林市中医医院感染性疾病科收治的老年CHF合并CAP患者161例为CHF合并CAP组,另选取同期87例单纯老年CHF患者为CHF组,随访3个月根据是否发生主要不良心血管事件分为预后不良组(n=95)和预后良好组(n=66)。计算各组患者GNRI,采用化学发光免疫分析方法检测患者血清NT-proBNP水平。进行多因素Logistic回归分析影响老年CHF合并CAP患者预后不良的因素,通过受试者工作特征曲线分析评估GNRI与血清NT-proBNP水平联合对老年CHF合并CAP患者预后的价值。结果与CHF组比较,CHF合并CAP组GNRI降低,血清NT-proBNP水平升高(P<0.05)。随访3个月,161例老年CHF合并CAP患者预后不良发生率为59.01%。与预后良好组比较,预后不良组GNRI降低,血清NT-proBNP水平升高(P<0.05)。老年CHF合并CAP患者预后不良的独立危险因素为纽约心脏病协会心功能分级Ⅳ级、机械通气、GNRI降低和NT-proBNP升高,独立保护因素为氧合指数、LVEF升高(P<0.05)。GNRI联合血清NT-proBNP水平评估老年CHF合并CAP患者预后不良的曲线下面积为0.867,大于GNRI、血清NT-proBNP水平单独评估的0.788、0.776(P<0.05)。结论老年CHF合并CAP患者GNRI降低和血清NT-proBNP水平升高,与预后不良密切相关,使用GNRI联合血清NT-proBNP水平评估老年CHF合并CAP患者预后具有较高的预测价值。Objective To investigate the prognostic value of the geriatric nutritional risk index(GNRI)combined with serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels in elderly patients with chronic heart failure(CHF)combined with community-acquired pneumonia(CAP).Methods 161 elderly patients with CHF combined with CAP admitted to the Department of infectious diseases of Yulin Traditional Chinese Medicine Hospital from January 2021 to May 2023(CHF combined with CAP group)were selected,and another 87 elderly patients with CHF alone during the same period(CHF group)were selected,and were classified into the group with poor prognosis(95 cases)and the group with good prognosis(66 cases)according to whether or not they suffered from a major adverse cardiovascular event at a follow-up period of 3 months.GNRI was calculated and serum NT-proBNP levels were measured by chemiluminescence immunoassay.Multifactorial logistic regression was used to analyze the factors of poor prognosis in elderly patients with CHF combined with CAP,and a receiver operating characteristic curve was used to analyze the value of GNRI combined with serum NT-proBNP levels in assessing poor prognosis in elderly patients with CHF combined with CAP.Results Compared with the CHF group,the CHF combined with CAP group had lower GNRI and higher serum NT-proBNP levels(P<0.05).At 3-month follow-up,the incidence of poor prognosis in 161 elderly patients with CHF combined with CAP was 59.01%.Compared with the group with good prognosis,the group with poor prognosis had lower GNRI and higher serum NT-proBNP levels(P<0.05).New York Heart Association cardiac function classⅣ,mechanical ventilation,reduced GNRI,and elevated NT-proBNP were independent risk factors for poor prognosis in elderly patients with CHF combined with CAP,and elevated oxygenation index and LVEF were independent protective factors(P<0.05).The area under the curve for GNRI combined with serum NT-proBNP levels to assess poor prognosis in elderly patients with CHF combined with CAP was 0.8

关 键 词：老年慢性心力衰竭 社区获得性肺炎 老年营养风险指数 N末端脑钠肽前体 预后 

分 类 号：R541.6[医药卫生—心血管疾病]