B型钠尿肽对社区获得性肺炎危险分层的价值
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摘要
目的探讨B型钠尿肽(BNP)的动态变化水平与社区获得性肺炎(CAP)患者病情危重情况之间的关系,从而探索BNP对CAP患者危险分层的价值。方法选取2017年1月至2018年1月首都医科大学附属复兴医院急诊科收治的58例CAP患者为研究对象,测定患者的BNP、C反应蛋白(CRP)水平,以及肺炎严重度评分(PSI)所需相关指标,计算PSI评分。根据病情程度将患者分为重症肺炎组(n=12)和非重症肺炎组(n=46),分析不同组患者的BNP水平;根据患者预后分为幸存组(n=49)和死亡组(n=9),比较两组患者间BNP差异、BNP水平与PSI评分的受试者工作特征(ROC)曲线。结果就诊时,38例患者有呼吸急促,25例患者血氧饱和度低于92%。PSI评分为(92±19)分,CRP中位值为110 mg/L(38,206),BNP中位值为170 pg/ml(72,528)。BNP水平随着CAP严重程度(PSI评分)增加而升高(r=0. 787,P <0. 01),重症肺炎组患者BNP水平显著高于非重症肺炎组[(459. 62±27. 83) pg/ml vs.(210. 35±23. 41) pg/ml,P <0. 05]。相比幸存组的BNP值[中位值为160 pg/ml(61,291)],死亡组的BNP值明显升高[中位值为372 pg/ml(291,1 300),P=0. 002]。BNP能预测死亡(AUC=0. 821),其预测死亡最佳截点为282. 0 pg/ml,灵敏度为89%,特异性为76%,阳性预测值为40%,阴性预测值为97%。使用BNP预测死亡的ROC曲线下面积(0. 821,95%CI:0. 697～0. 945)高于PSI评分的曲线下面积(0. 553,95%CI:0. 362～0. 745)。结论 BNP预测CAP严重程度具有一定的实用性,并且可以早期识别高危患者,优化医疗资源利用。
Objective To investigate B-type natriuretic peptide regarding risk stratification of patients with community acquired pneumonia( CAP). Methods A total of 58 patients with CAP admitted to the emergency department of our hospital from January 2017 to January 2018 were enrolled. All patients were tested for BNP level,C-reactive protein( CRP),as well as other component markers of pneumonia severity index( PSI). They were divided into severe pneumonia group( n = 12) and non-severe pneumonia group( n = 46) as well as survivor group( n =49) and death group( n = 9). BNP levels between the two groups were compared,and ROC curve analysis was performed regarding BNP levels versus PSI. Results On admission,38 patients had shortness of breath. 25 patients had less than 92% of blood oxygen saturation. The PSI was92 ± 19,median CRP being 110 mg/L( 38,206) and median BNP 170 pg/ml( 72,528). BNP levels increased with CAP severity( r = 0. 787,P < 0. 01). BNP level in severe group was significantly higher than in non-severe group [( 459. 62 ± 27. 83) pg/ml vs.( 210. 35 ± 23. 41) pg/ml,P < 0. 05]. Compared with survivor group [n = 49; median 160 pg/ml( 61,291) ],those died in 30 days had significantly higher BNP level[n = 9; median 372 pg/ml( 291,1300),P = 0. 002]. BNP level had definite accuracy in predicting mortality( AUC = 0. 821) with optimal cut-off point 282. 0 pg/ml. Sensitivity: 89%. Specificity: 76%. Negative predictive value: 97%. Positive predictive value: 40%. The AUC( 0. 821; 95% CI,0. 697-0. 945) under BNP mortality prediction curve was higher than AUC of PSI curve( 0. 553; 95% CI,0. 362-0. 745).Conclusion BNP is positively correlated with CAP risk stratification and can directly reflect CAP severity. Early identification of high-risk patients can optimize resource allocation.
Objective To investigate B-type natriuretic peptide regarding risk stratification of patients with community acquired pneumonia( CAP). Methods A total of 58 patients with CAP admitted to the emergency department of our hospital from January 2017 to January 2018 were enrolled. All patients were tested for BNP level,C-reactive protein( CRP),as well as other component markers of pneumonia severity index( PSI). They were divided into severe pneumonia group( n = 12) and non-severe pneumonia group( n = 46) as well as survivor group( n =49) and death group( n = 9). BNP levels between the two groups were compared,and ROC curve analysis was performed regarding BNP levels versus PSI. Results On admission,38 patients had shortness of breath. 25 patients had less than 92% of blood oxygen saturation. The PSI was92 ± 19,median CRP being 110 mg/L( 38,206) and median BNP 170 pg/ml( 72,528). BNP levels increased with CAP severity( r = 0. 787,P < 0. 01). BNP level in severe group was significantly higher than in non-severe group [( 459. 62 ± 27. 83) pg/ml vs.( 210. 35 ± 23. 41) pg/ml,P < 0. 05]. Compared with survivor group [n = 49; median 160 pg/ml( 61,291) ],those died in 30 days had significantly higher BNP level[n = 9; median 372 pg/ml( 291,1300),P = 0. 002]. BNP level had definite accuracy in predicting mortality( AUC = 0. 821) with optimal cut-off point 282. 0 pg/ml. Sensitivity: 89%. Specificity: 76%. Negative predictive value: 97%. Positive predictive value: 40%. The AUC( 0. 821; 95% CI,0. 697-0. 945) under BNP mortality prediction curve was higher than AUC of PSI curve( 0. 553; 95% CI,0. 362-0. 745).Conclusion BNP is positively correlated with CAP risk stratification and can directly reflect CAP severity. Early identification of high-risk patients can optimize resource allocation.
引文
[1]Niederman MS.Guidelines for the management of community-acquired pneumonia.Current recommendations and antibiotic selection issues[J].Med Clin North Am,2001,85(6):1493-1509.
[2]Mortensen EM,Coley CM,Singer DE,et al.Causes of death for patients with community-acquired pneumonia:results from the Pneumonia Patient Outcomes Research Team cohort study[J].Arch Intern Med,2002,162(9):1059-1064.
[3]Mandell LA,Wunderink RG,Anzueto A,et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J].Clin Infect Dis,2007,44 Suppl 2:S27-72.
[4]赖丽仁,王臻,童朝晖.B型钠尿肽与机械通气的撤离[J].中华结核和呼吸杂志,2013,36(2):113-115.
[5]Nadia Aspromonte,Michele Massimo Gulizia,Aldo Clerico,et al.AN-MCO/ELAS/SIBioC Consensus Document:biomarkers in heart failure[J].Eur Heart J Suppl,2017,19(Suppl D):102-112.
[6]Harsimar Singh,Daryl Ramai et al.B-Type Natriuretic Peptide:A Predictor for Mortality,Intensive Care Unit Length of Stay,and Hospital Length of Stay in Patients With Resolving Sepsis[J].Cardiol Res,2017,8(6):271-275.
[7]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[8]徐波,王浩彦,贾海鑫,等.多因素分析评估社区获得性肺炎病情和预后对呼吸系统感染性疾病临床诊疗及教学思路的启示[J].临床和实验医学杂志,2016,15(20):2062-2064.
[9]李京,叶寰,赵丽.B型钠尿肽预测社区获得性肺炎严重程度的意义[J].中华急诊医学杂志,2014,23(10):1132-1137.
[10]Tomoko Ichiki,Guido Boerrigter,Brenda K.Huntley,et al.Differential expression of the pro-natriuretic peptide convertases corin and furin in experimental heart failure and atrial fibrosis[J].Am J Physiol Regul Integr Comp Physiol,2013,304(2):R102-R109.
[11]Disomma S,Magrini L,Pittoni V,et al.Usefulness of serial assessment of natriuretic peptides in the emergency department for patients with acute decompensated heart failure[J].Congest Heart Fail,2008,14(4Suppl 1):21-24.
[12]Mueller C,Laule-Kilian K,Schindler C,et al.Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea[J].Arch Intern Med,2006,166(10):1081-1087.
[13]陈占龙,杨腊梅,陈梦飞,等.血清BNP检测在急性呼吸困难鉴别诊断中的作用[J].宁夏医学杂志,2017,39(2):118-120.
[14]Zu H,Li Q,Huang P,et al.Therapeutic Value of Blood Purifcation and Prognostic Utilities of Early Serum Procalcitonin,C Reactive Protein,and Brain Natriuretic Peptide Levels in Severely Burned Patients with Sepsis[J].Cell Biochem Biophys,2015,72(1):259-263.
[15]Brian Casserly,James R Klinger.Brain natriuretic peptide in pulmonary arterial hypertension:biomarker and potential therapeutic agent[J].Drug Des Devel Ther,2009,3:269-287.
[16]Hopkins WE,Chen Z,Fukagawa NK,et al.Increased atrial and brain natriuretic peptides in adults with cyanotic congenital heart disease:enhanced understanding of the relationship between hypoxia and natriuretic peptide secretion[J].Circulation,2004,109(23):2872-2877.
[17]Yap LB,Mukerjee D,Timms PM,et al.Natriuretic peptides,respiratory disease,and the right heart[J].Chest,2004,126(4):1330-1336.
[18]Tsuneo Ogawa,Adolfo J.Brain Natriuretic Peptide Production and Secretion in Inflammation[J].de Bold J Transplant,2012,2012:962347.
[19]Ma KK,Ogawa T,de Bold AJ.Selective upregulation of cardiac brain natriuretic peptide at the transcriptional and translational levels by proinflammatory cytokines and by conditioned medium derived from mixed lymphocyte reactions via p38 MAP kinase[J].J Mol Cell Cardiol,2004,36(4):505-513.
[2]Mortensen EM,Coley CM,Singer DE,et al.Causes of death for patients with community-acquired pneumonia:results from the Pneumonia Patient Outcomes Research Team cohort study[J].Arch Intern Med,2002,162(9):1059-1064.
[3]Mandell LA,Wunderink RG,Anzueto A,et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J].Clin Infect Dis,2007,44 Suppl 2:S27-72.
[4]赖丽仁,王臻,童朝晖.B型钠尿肽与机械通气的撤离[J].中华结核和呼吸杂志,2013,36(2):113-115.
[5]Nadia Aspromonte,Michele Massimo Gulizia,Aldo Clerico,et al.AN-MCO/ELAS/SIBioC Consensus Document:biomarkers in heart failure[J].Eur Heart J Suppl,2017,19(Suppl D):102-112.
[6]Harsimar Singh,Daryl Ramai et al.B-Type Natriuretic Peptide:A Predictor for Mortality,Intensive Care Unit Length of Stay,and Hospital Length of Stay in Patients With Resolving Sepsis[J].Cardiol Res,2017,8(6):271-275.
[7]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[8]徐波,王浩彦,贾海鑫,等.多因素分析评估社区获得性肺炎病情和预后对呼吸系统感染性疾病临床诊疗及教学思路的启示[J].临床和实验医学杂志,2016,15(20):2062-2064.
[9]李京,叶寰,赵丽.B型钠尿肽预测社区获得性肺炎严重程度的意义[J].中华急诊医学杂志,2014,23(10):1132-1137.
[10]Tomoko Ichiki,Guido Boerrigter,Brenda K.Huntley,et al.Differential expression of the pro-natriuretic peptide convertases corin and furin in experimental heart failure and atrial fibrosis[J].Am J Physiol Regul Integr Comp Physiol,2013,304(2):R102-R109.
[11]Disomma S,Magrini L,Pittoni V,et al.Usefulness of serial assessment of natriuretic peptides in the emergency department for patients with acute decompensated heart failure[J].Congest Heart Fail,2008,14(4Suppl 1):21-24.
[12]Mueller C,Laule-Kilian K,Schindler C,et al.Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea[J].Arch Intern Med,2006,166(10):1081-1087.
[13]陈占龙,杨腊梅,陈梦飞,等.血清BNP检测在急性呼吸困难鉴别诊断中的作用[J].宁夏医学杂志,2017,39(2):118-120.
[14]Zu H,Li Q,Huang P,et al.Therapeutic Value of Blood Purifcation and Prognostic Utilities of Early Serum Procalcitonin,C Reactive Protein,and Brain Natriuretic Peptide Levels in Severely Burned Patients with Sepsis[J].Cell Biochem Biophys,2015,72(1):259-263.
[15]Brian Casserly,James R Klinger.Brain natriuretic peptide in pulmonary arterial hypertension:biomarker and potential therapeutic agent[J].Drug Des Devel Ther,2009,3:269-287.
[16]Hopkins WE,Chen Z,Fukagawa NK,et al.Increased atrial and brain natriuretic peptides in adults with cyanotic congenital heart disease:enhanced understanding of the relationship between hypoxia and natriuretic peptide secretion[J].Circulation,2004,109(23):2872-2877.
[17]Yap LB,Mukerjee D,Timms PM,et al.Natriuretic peptides,respiratory disease,and the right heart[J].Chest,2004,126(4):1330-1336.
[18]Tsuneo Ogawa,Adolfo J.Brain Natriuretic Peptide Production and Secretion in Inflammation[J].de Bold J Transplant,2012,2012:962347.
[19]Ma KK,Ogawa T,de Bold AJ.Selective upregulation of cardiac brain natriuretic peptide at the transcriptional and translational levels by proinflammatory cytokines and by conditioned medium derived from mixed lymphocyte reactions via p38 MAP kinase[J].J Mol Cell Cardiol,2004,36(4):505-513.