血清N末端B型钠尿肽前体在重症肺炎病原诊断中的价值

摘要

Objective To discuss whether N-terminal fragment of brain natriuretic peptide prohormone could prognose the pathogens in patients who suffered severe pneumonia concomitant with sepsis.Method Retrospectively analyzing 115 patients who suffered severe pneumonia concomitant with sepsis and were admitted to ICU of Zhangzhou Municipal Hospital Affiliated to Fujian Medical University from January,2013 to July,2015.The sputum culture of all these patients was positive.According to the sputum culture,the cases were divided into Gram-positive group (42 cases),Gram-negative group (58 cases) and fungal group (15 cases).The levels of N-terminal fragment of brain natriuretic peptide prohormone (NT-proBNP),commercial rent planning (CRP),procalcitonin (PCT) and white blood cell (WBC) count were compared among three groups.Results Gram-negative group had significantly higher levels of CRP and NT-proBNP than those of Gram-positive group and fungal group.However,the differences of CRP and WBC count among three groups were not statistically significant(P>0-05).ROC curve was drawn to evaluate the value of the level of serum NT-proBNP to distinguish the G-bacteria from the non-G-bacteria.The area under curve was 0-957(95%CI was 0-926~0-989).The diagnostic threshold was >370-5ng/L with 91-2% specificity and 84-5% sensitivity.Conclusion The high levels of NT-proBNP and PCT of patients who suffered severe pneumonia concomitant with sepsis can be used to early determine the pathogens with high sensitivity and specificity.%目的 评价血清N末端B型钠尿肽前体(NT-proBNP)水平是否可以预测重症肺炎并脓毒血症的不同病原体.方法 回顾性分析福建医科大学附属漳州市医院内科ICU 2013-01-2015-07间收治的重症肺炎并脓毒血症,同时痰培养阳性的患者115例,根据痰培养结果分成革兰氏阳性菌(G+组)42例,革兰氏阴性菌(G-组)58例和真菌组15例,比较三组患者间NT-proBNP、C反应蛋白(CRP)、降钙素原(PCT)与白细胞(WBC)计数水平.结果 G-组患者的PCT明显高于G+组和真菌组,G-组患者的NT-proBNP明显高于G+和真菌组,三组差异有统计学意义(P<0-05).而CRP与WBC在三组间比较差异无统计学意义(P>0-05).为NTpro-BNP诊断是否由G-菌导致重症肺炎而描绘ROC曲线下面积为0-957(95% CI 0-926~0-989),诊断阈值为>370-5 ng/L,特异度为91-2%敏感度为84-5%.结论 血清NT-proBNP升高水平可以早期鉴别重症肺炎并脓毒血症的病原菌,具有较高的敏感度和特异度.