【摘要】 目的了解氮末端脑钠肽前体(NT-pro BNP)在不同降钙素原(PCT)水平社区获得性肺炎(CAP)患者中的临床意义。方法选取2012年1月—2013年12月,在首都医科大学附属北京潞河医院接受住院治疗的CAP患者287例。根据PCT水平,将其分为A(PCT<0.10μg/L,n=110)、B(0.10μg/L≤PCT≤0.25μg/L,n=99)、C(0.25μg/L<PCT≤0.50μg/L,n=31)、D(PCT>0.50μg/L,n=47)4组。比较并分析4组患者一般临床资料和各项实验室检测指标,分析NT-pro BNP与炎性标志物、全血肌钙蛋白I(TNI)及肺炎严重度指数(PSI)的相关性。结果(1)4组患者性别、平均年龄及合并症中的糖尿病比较,差异有统计学意义(P<0.05);合并症中慢性阻塞性肺疾病、哮喘、高血压、冠心病、心房纤颤及脑血管疾病比较,差异无统计学意义(P>0.05)。(2)4组患者体温、心率、呼吸频率、PCT、NT-pro BNP、氢离子浓度指数(p H)、氧分压(PO2)、氧合指数、白细胞计数(WBC)、中性粒细胞计数(NEUT)、红细胞沉降率(ESR)、C-反应蛋白(CRP)及PSI评分比较,差异有统计学意义(P<0.05);收缩压、舒张压、TNI及二氧化碳分压(PCO2)比较,差异无统计学意义(P>0.05)。(3)A组患者NT-pro BNP与C、D组比较,差异有统计学意义(P<0.05);B组患者NT-pro BNP与C、D组比较,差异有统计学意义(P<0.05);C组患者NT-pro BNP与D组比较,差异有统计学意义(P<0.05)。(4)Spearman相关分析显示,NT-pro BNP与TNI(rs=0.21,P<0.05)、PCT(rs=0.30,P<0.05)、WBC(rs=0.15,P<0.05)、NEUT(rs=0.25,P<0.05)、ESR(rs=0.23,P<0.05)、CRP(rs=0.40,P<0.05)及PSI(rs=0.54,P<0.05)均呈正相关。以PCT>0.25μg/L为截点,进一步行Spearman相关分析,结果显示,细菌感染患者中NT-pro BNP与PCT呈正相关(rs=0.40,P=0.00)。结论细菌感染加重可以导致患者NT-pro BNP水平增高,可能是由细菌内毒素通过炎性递质介导,推测NT-pro BNP可以作为反映CAP患者病情严重程度和预后的指标。更多还原

【Abstract】 Objective To investigate the clinical significance of N- terminal pro- BNP( NT- pro BNP) for patients with community- acquired pneumonia( CAP) of different PCT levels. Methods We enrolled 287 CAP patients who received hospitalized treatment in Beijing Luhe Hospital Affiliated to Captial Medical University from January 2012 to December2013. According to serum PCT level,the subjects were divided into four groups: group A( PCT < 0. 10 μg / L,n = 110),group B( 0. 10 μg / L≤PCT≤0. 25 μg / L,n = 99),group C( 0. 25 μg / L < PCT≤0. 50 μg / L,n = 31) and group D( PCT > 0. 50μg /L,n = 47). The general clinical data and each laboratory examination indicator were analyzed and compared among the four groups,and the correlation between NT- pro BNP and inflammatory markers,TNI and PSI was analyzed. Results( 1) The four groups were significantly different( P < 0. 05) in gender,average age and diabetes mellitus in complications and were not significantly different( P > 0. 05) in chronic obstructive pulmonary disease, asthma, hypertension, coronary heart disease,atrial fibrillation and cerebrovascular diseases in complications.( 2) The four groups were significantly different( P < 0. 05) in temperature,heart rate, respiratory rate, PCT, NT- pro BNP, PH, PO2,oxygenation index,WBC,NEUT,ESR,CRP,the score of PSI and were not significantly different( P > 0. 05) in systolic pressure,diastolic pressure,TNI and PCO2.( 3)Group A was significantly different( P < 0. 05) in NT- pro BNP from group C and group D,group B was significantly different( P < 0. 05) in NT- pro BNP from group C and group D,and group C was significantly different( P < 0. 05) in NT- pro BNP from group D.( 4) The Spearman correlation analysis showed that NT- pro BNP was positively correlated with TNI( rs= 0. 21,P < 0. 05),PCT( rs= 0. 30,P < 0. 05),WBC( rs= 0. 15,P < 0. 05),NEUT( rs= 0. 25,P < 0. 05),ESR( rs= 0. 23,P < 0. 05),CRP( rs= 0. 40,P < 0. 05) and PSI( rs= 0. 54,P < 0. 05). With PCT > 0. 25 μg / L as the cutoff point,the Spearman correlation analysis was further conducted,and the results showed that NT- pro BNP was positively correlated with PCT in patients with bacterial infection( rs= 0. 40,P = 0. 00). Conclusion The exacerbation of bacterial infection could lead to the increase of NT- pro BNP level in patients, which may be mediated by bacterial endotoxin through inflammatory medium.NT- pro BNP can be used as an indicator of disease severity degree and prognosis of CAP patients.更多还原