B型钠尿肽前体与非心源性危重症患儿预后的关系
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摘要
目的探讨B型钠尿肽前体(pro-BNP)与非心源性危重症患儿预后的关系。方法选取50例非心源性危重症患儿,根据入院后96 h内血清pro-BNP水平分为研究组27例(pro-BNP>300 pg/ml)、对照组23例(pro-BNP≤300 pg/ml)。比较两组患儿治疗前后的急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)得分,ICU入住时间,总住院时间,住院费用,发生多器官功能障碍综合征(MODS)时衰竭器官数目、机械通气使用率、住院期间和6个月随访期间的死亡情况。结果治疗后两组的APACHEⅡ评分均降低(P <0. 05),但研究组APACHEⅡ评分仍高于对照组(P <0. 05)。研究组ICU入院时间和总住院时间均长于对照组,住院费用多于对照组,MODS发生时衰竭器官数、机械通气率均高于对照组(均P <0. 05)。两组住院病死率及6个月随访期间死亡者比例比较,差异无统计学意义(P> 0. 05)。结论对于非心源性危重症患儿,血清pro-BNP水平越高预后可能越差,pro-BNP在预后评估中有一定的价值。
Objective To investigate the relationship between pro-B-type natriuretic peptide( pro-BNP) and prognosis in the children with non-cardiac critical illness. Methods Fifty children with non-cardiac critical illness were enrolled. The children were divided into study group( n = 27,pro-BNP > 300 pg/ml) and control group( n = 23,pro-BNP≤300 pg/ml) according to their pro-BNP levels within96 hours after admission. The indices of the children were compared between the two groups,including the scores of Acute Physiology And Chronic Health EvaluationⅡ( APACHEⅡ) before and after treatment,ICU stay,total hospital stay,hospitalization costs,the number of organs with dysfunction when multiple organ dysfunction syndrome( MODS) occurred,the mechanical ventilation rate,the death rate during hospitalization and the 6-month of follow-up. Results After treatment,the APACHEⅡ scores of both groups decreased( P < 0. 05),but the APACHEⅡscore of the study group was still higher than that of the control group( P < 0. 05). Compared to the control group,the study group had longer ICU stay and total hospital stay,more hospitalization costs,more organs with dysfunction when MODS occurred,and higher mechanical ventilation rate( all P < 0. 05). There was no statistically significant difference in the death rate during hospitalization or proportion of deaths occurred in the 6-month of follow-up( P > 0. 05). Conclusion For the children with non-cardiac critical illness,the prognosis is probably more poorer when the serum pro-BNP level is higher,and pro-BNP is valuable for prognosis evaluation in a certain degree.
Objective To investigate the relationship between pro-B-type natriuretic peptide( pro-BNP) and prognosis in the children with non-cardiac critical illness. Methods Fifty children with non-cardiac critical illness were enrolled. The children were divided into study group( n = 27,pro-BNP > 300 pg/ml) and control group( n = 23,pro-BNP≤300 pg/ml) according to their pro-BNP levels within96 hours after admission. The indices of the children were compared between the two groups,including the scores of Acute Physiology And Chronic Health EvaluationⅡ( APACHEⅡ) before and after treatment,ICU stay,total hospital stay,hospitalization costs,the number of organs with dysfunction when multiple organ dysfunction syndrome( MODS) occurred,the mechanical ventilation rate,the death rate during hospitalization and the 6-month of follow-up. Results After treatment,the APACHEⅡ scores of both groups decreased( P < 0. 05),but the APACHEⅡscore of the study group was still higher than that of the control group( P < 0. 05). Compared to the control group,the study group had longer ICU stay and total hospital stay,more hospitalization costs,more organs with dysfunction when MODS occurred,and higher mechanical ventilation rate( all P < 0. 05). There was no statistically significant difference in the death rate during hospitalization or proportion of deaths occurred in the 6-month of follow-up( P > 0. 05). Conclusion For the children with non-cardiac critical illness,the prognosis is probably more poorer when the serum pro-BNP level is higher,and pro-BNP is valuable for prognosis evaluation in a certain degree.
引文
[1]俞江.危重症患儿早期心血管功能异常评估与氨基末端B型脑钠肽的关系[J].实用医学杂志,2014,30(17):2 784-2 786.
[2]韩明英,王淑丽,李建厂,等.危重症婴儿血清N末端脑利钠肽前体对预后的预测价值研究[J].中国小儿急救医学,2015,22(9):610-613.
[3]张玉凤,邓慧玲,符佳,等.脑利钠肽及心肌酶CK-MB与手足口病的相关研究[J].中国妇幼健康研究,2016,27(4):472-475.
[4]张玲,陈梦飞,杨晓明,等.血清BNP在危重症患者急性肾损伤预警的临床价值[J].宁夏医学杂志,2017,39(2):114-115.
[5]陈瑶,于永慧.氨基末端B型脑钠肽前体在早期评估危重症患儿心血管功能障碍中的价值[J].中华儿科杂志,2014,52(2):149-152.
[6]王卫平.儿科学[M]. 8版.北京:人民卫生出版社,2013:238-240.
[7]张玲,杨红年,陈梦飞,等.血清BNP临床应用及其在急性肾损伤诊断中的价值[J].宁夏医学杂志,2016,38(12):1 294-1 297.
[8]王坤,高松,许林艳. NT-proBNP检测在心力衰竭诊断中应用的临床价值[J].浙江临床医学,2014(9):1 465-1 466.
[9]周玥,傅永平.血浆B型利钠肽在不同左心功能肺心病患者中的临床价值探讨[J].中华危重症医学杂志(电子版),2016,9(3):184-186.
[10]高伟,吴炬,邱镞文,等. B型脑钠肽前体在慢性阻塞性肺病急性加重期合并心功能不全中的临床应用[J].职业卫生与病伤,2016,31(5):305-308.
[11]熊琼,王龙,王晞.脑钠肽及氨基末端B型脑钠肽前体在脓毒症中的作用[J].中华危重症医学杂志(电子版),2017,10(2):130-135.
[12]唐诚. N端脑钠肽对急性冠脉综合征及心力衰竭的影响[J].现代中西医结合杂志,2015(13):1 481-1 482.
[13]徐建国,潘娅静,李钰,等. N末端B型钠尿肽前体在1型心肾综合征早期诊断中的应用价值[J].中华危重症医学杂志(电子版),2014,7(2):93-97.
[2]韩明英,王淑丽,李建厂,等.危重症婴儿血清N末端脑利钠肽前体对预后的预测价值研究[J].中国小儿急救医学,2015,22(9):610-613.
[3]张玉凤,邓慧玲,符佳,等.脑利钠肽及心肌酶CK-MB与手足口病的相关研究[J].中国妇幼健康研究,2016,27(4):472-475.
[4]张玲,陈梦飞,杨晓明,等.血清BNP在危重症患者急性肾损伤预警的临床价值[J].宁夏医学杂志,2017,39(2):114-115.
[5]陈瑶,于永慧.氨基末端B型脑钠肽前体在早期评估危重症患儿心血管功能障碍中的价值[J].中华儿科杂志,2014,52(2):149-152.
[6]王卫平.儿科学[M]. 8版.北京:人民卫生出版社,2013:238-240.
[7]张玲,杨红年,陈梦飞,等.血清BNP临床应用及其在急性肾损伤诊断中的价值[J].宁夏医学杂志,2016,38(12):1 294-1 297.
[8]王坤,高松,许林艳. NT-proBNP检测在心力衰竭诊断中应用的临床价值[J].浙江临床医学,2014(9):1 465-1 466.
[9]周玥,傅永平.血浆B型利钠肽在不同左心功能肺心病患者中的临床价值探讨[J].中华危重症医学杂志(电子版),2016,9(3):184-186.
[10]高伟,吴炬,邱镞文,等. B型脑钠肽前体在慢性阻塞性肺病急性加重期合并心功能不全中的临床应用[J].职业卫生与病伤,2016,31(5):305-308.
[11]熊琼,王龙,王晞.脑钠肽及氨基末端B型脑钠肽前体在脓毒症中的作用[J].中华危重症医学杂志(电子版),2017,10(2):130-135.
[12]唐诚. N端脑钠肽对急性冠脉综合征及心力衰竭的影响[J].现代中西医结合杂志,2015(13):1 481-1 482.
[13]徐建国,潘娅静,李钰,等. N末端B型钠尿肽前体在1型心肾综合征早期诊断中的应用价值[J].中华危重症医学杂志(电子版),2014,7(2):93-97.