血浆N-末端B型利钠肽原对ICU重症患者预后的预测价值

摘要

目的 探讨血浆N-末端B型利钠肽原(NT-proBNP)水平对ICU重症患者预后的预测价值.方法 回顾2011年10月～2012年4月北京市仁和医院ICU收治的137例患者临床资料,患者入院即时行急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分,并于入ICU第1天、第2天、第3天、第5天、第7天采用酶联免疫吸附法(ELISA)测定血浆NT-proBNP水平,计算患者28 d病死率,分析血浆NT-proBNP与APACHEⅡ对患者预后的预测价值.结果 137例患者28 d病死率为31.39%(43/137),94例存活(存活组),43例死亡(死亡组).死亡组严重感染患者多,APACHE Ⅱ评分高(P ＜ 0.05).存活组与死亡组血浆NT-proBNP水平均于入ICU第2天到达峰值;死亡组第2天、第3天、第5天和第7天血浆NT-proBNP水平均显著高于存活组(P ＜ 0.05).多因素分析显示,NT-proBNP＞ 1 565.2 ng/L及APACHEⅡ评分均可预测患者28 d病死率(P ＜ 0.05).结论 NT-proBNP＞ 1 565.2 ng/L及APACHEⅡ评分是ICU重症患者28 d病死率的独立预测因子,NT-proBNP＞ 1 565.2 ng/L及APACHEⅡ评分越高,提示患者预后不良,可为临床诊断及指导治疗提供借鉴.%Objective To investigate the value of plasma N-terminal probrain natriuretic peptide (NT-pro-BNP) in predicting the prognosis of critically ill patients in ICU. Methods A total of 137 patients in ICU of Beijing Renhe Hospital from October 2011 to April 2012 were evaluated by using acute physiology and chronic health evaluation II (APACHE II), and the level of plasma NT-proBNP was determined on the first day, second day, third day, fifth day and seventh day after admitted into ICU by using ELISA, the 28-day mortality was calculated, then the values of plasma NT-proBNP and A-PACHE H score in predicting the prognosis of patients were also analyzed. Results The 28-day mortality of patients was 31.39% (43/137), 94 patients were survival (survival group) and 43 patients were non-survival (non-survival group). The patients in non-survival group were older than the surviva group,suffered more severe infection, and had higher APACHEH score than the survival group (P < 0.05). Both survival group and non-survival group had the highest level of plasma NT-proBNP on the second day after admitted into ICU; the level of plasma NT-proBNP on the second day, third day, fifth day and seventh day after admitted into ICU of non-survival group were higher than those of survival group (P < 0.05). Multiplicity analysis showed that, both the level of plasma NT-proBNP>l 565.2 ng/L and APACHE I[ score could predict the 28-day mortality (P < 0.05). Conclusion The level of plasma NT-proBNP> 1 565.2 ng/L and APACHE I score are the independent predictive factors for the 28-day mortality of critically ill patients in ICU, NT-proBNP> 1 565.2 ng/L and higher APACHE II score indicate poor prognosis for critically ill patients, which can provide reference for the clinical diagnosis and guiding treatment.