诊断学理论与实践

诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (03): 319-322.doi: 10.16150/j.1671-2870.2019.03.014

• 论著 • 上一篇    下一篇

脑钠肽前体水平对无心力衰竭史的肺炎高龄住院患者预后的判断价值研究

罗晓颖a, 朱雪梅b(), 许燕a, 张凤如a, 吴立群a, 戚文航a   

  1. a.上海交通大学医学院附属瑞金医院 心内科,上海 200025
    b.上海交通大学医学院附属瑞金医院 呼吸科,上海 200025
  • 收稿日期:2019-03-26 出版日期:2019-06-25 发布日期:2019-06-25
  • 通讯作者: 朱雪梅 E-mail:xmzhu2@163.com
  • 基金资助:
    国家自然科学基金青年项目(81500196)

Value of NT-proBNP level in predicting prognosis of hospitalized elderly pneumonia patients without heart failure history

LUO Xiaoyinga, ZHU Xuemeib(), XU Yana, ZHANG Fengrua, WU Liquna, QI Wenhanga   

  1. a. Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    b. Department of Respiration, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2019-03-26 Online:2019-06-25 Published:2019-06-25
  • Contact: ZHU Xuemei E-mail:xmzhu2@163.com

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摘要：

目的： 分析脑钠肽前体水平对无心衰史肺炎高龄患者预后的判断价值。方法： 选择2015年6月至2018年12月在本院急诊测定了N端脑钠肽前体（N-terminal pro-brain natriuretic peptide, NT-proBNP）且收治入院的无心衰史高龄肺炎患者503例,按NT-proBNP值四分位间距将患者分为低水平组、较低水平组、较高水平组和高水平组。根据患者院内是否发生死亡再分为死亡组（n=125）和生存组（n=378）。应用受试者工作特征曲线（receiver operating characteristic curve, ROC曲线）分析NT-proBNP对预后的预测作用及最佳临界值。采用多因素Cox 回归分析NT-proBNP对无心衰史肺炎高龄患者预后的影响。结果： 不同NT-proBNP值分组间的院内死亡发生率有差异,高水平组最高（≥1 502.4 pg/mL）,达49.2 %,显著高于其他各组（P<0.05）。与生存组比较,死亡组入院前及入院1、3、7 d的血浆NT-proBNP、血肌酐、C反应蛋白水平显著升高;而血红蛋白、血清白蛋白、肾小球滤过率水平显著降低（P<0.05）;合并房颤的发生率更高(35.8%比16.1%); 院前肾素-血管紧张素系统（renin-angiotensin system, RAS）抑制剂使用率更低（P<0.05）。ROC曲线显示,NT-proBNP 水平预测患者发生院内死亡的曲线下面积为0.714（95%CI为0.504~0.925, P<0.01）,最佳临界值为1 377.8 pg/mL。多变量Cox回归分析显示,NT-proBNP（≥1 377.8 pg/mL）、血红蛋白（<131 g/L）、白蛋白（<35 g/L）是无心衰史肺炎高龄患者发生院内死亡的独立危险因素（P<0.05）。结论： NT-proBNP水平对无心衰史肺炎高龄住院患者具有一定的临床预后价值。

关键词: N端脑钠肽前体, 高龄, 肺炎, 无心衰史, 预后

Abstract:

Objective: To analyze the value of NT-proBNP level in predicting prognosis of elderly pneumonia patients without heart failure history. Methods: A total of 503 hospitalized elderly pneumonia patients without heart failure history admitted from June 2015 to December 2018 and had NT-proBNP level detected at emergency room were enrolled. According to the interquartile range of serum NT-proBNP, patients were divided into low level group, lower level group, higher level group, and high level group. And according to the occurrence of death in hospital, patients were divided into death group (n=125) and survival group (n=378). The receiver operating characteristic curve (ROC) was used to analyze the predictive value of NT-proBNP on prognosis of elderly pneumonia patients without heart failure history and the optimal cutoff value.And multi-factor Cox regression analysis was used to analyze the influence of NT-proBNP level on prognosis of elderly pneumonia patients without heart failure history. Results: There was a difference in mortality between different groups of NT-proBNP level, and it was the highest in high level group (49.2%) (P<0.05). Compared with survival group, the NT-proBNP, serum creatinine, C reactive protein level were significantly higher and hemoglobin, serum albumin, estimated glomerular filtration rate were significantly lower（P<0.05）in death group; the occurrence of atrial fibrillation was higher and use of RAS blockers before admission was lower (P<0.05). Area under ROC (AUC) of NT-proBNP to predict in-hospital death was 0.714(95%CI: 0.504-0.925, P<0.01). The optimal cut-off value was 1 377.8 pg/mL, with a sensitivity of 75.8% and a specificity of 76.4%. Cox regression analysis indicated that NT-proBNP level（≥1 377.8 pg/mL）, hemoglobin (<131 g/L) and serum albumin(<35 g/L) were independent risk factors for the hospitalized elderly pneumoniapatients without heart failure (P<0.05). Conclusions: Serum NT-proBNP level has a substantial value for predicting the prognosis in elderly pneumonia patients without heart failurehistory.

Key words: NT-proBNP, Elderly patient, Pneumonia, Without heart failure history, Prognosis

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