急诊患者血清N末端脑钠肽前体水平与病情评估及预后的相关性研究

摘要

目的：探讨急诊患者血清 N 末端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）水平与其病情评估及预后的相关性。方法选择208例急诊科患者为研究对象，24 h 内完成血 NT-proBNP 水平测定并按照急性生理与慢性健康评分Ⅱ（acute physiology and chronic health evaluation system Ⅱ，APACHE Ⅱ）将患者分组，分析不同 APACHE Ⅱ评分分组的 NT-proBNP 水平是否有差异及二者之间的相关性，并按照随访3个月后存活与否、左心室射血分数（left ventricular ejection fraction，LVEF）是否大于50%，分组比较患者的 NT-proBNP 水平、APACHE Ⅱ评分的情况。结果不同 APACHE Ⅱ分值组患者血清 NT-proBNP 水平存在差异（χ2=68.07，P ＜0.01），且血清 NT-proBNP 水平与 APACHE Ⅱ评分呈正相关（rs=0.60， P ＜0.01）。随访3个月,死亡组较存活组血清 NT-proBNP 水平高，相应 APACHE Ⅱ评分也高，且两组间差异均有统计学意义（Z=6.50，P ＜0.01；t’=-16.65, P ＜0.01）。与 LVEF ＞50%组相比，LVEF ≤50%组血清 NT-proBNP 水平明显增高，且差异有统计学意义（Z=7.72，P ＜0.01）；但两组 APACHE Ⅱ评分差异无统计学意义（t’=-1.44, P=0.16）。结论急诊患者血清 NT-proBNP 水平与其病情及病死率可能正相关，其可作为患者病情评估及预后的指标。%Objective To explore relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and condition assessment and prognosis of patients in department of emergency. Methods 208 patients from department of emergency were recruited as research objects. Serum level of NT-proBNP was measured and patients were grouped according to acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ ) score within the first 24 h after admission. The relationship between serum NT-proBNP and APACHE Ⅱ score, and their relationships with fatality rate and left ventricular ejection fraction (LVEF) of emergency patients were analyzed. Results Serum NT-proBNP levels showed statistically significant differences among different APACHEⅡscore groups (χ2=68.07, P<0.01). The level of serum NT-proBNP was positively correlated with APACHE Ⅱ score (rs=0.60,P < 0.01). Patients were followed up for 3 months, NT-proBNP level (Z=6.50,P < 0.01) and APACHE Ⅱ score (t’=-16.65,P < 0.01) in death group were significantly higher than those in survival group (P < 0.05). NT-proBNP level in group LVEF ≤ 50% was higher than that in group LVEF > 50%(Z=7.72,P < 0.01), but the difference of APACHE Ⅱ score between two groups had no statistical significance. Conclusions Serum NT-proBNP level is positively correlated with patient’s condition and fatality rate, and may be applied to evaluate condition and prognosis of emergency patients.