血清N末端B型脑钠肽前体、降钙素原在急性呼吸窘迫综合征中的临床应用价值

摘要

目的 研究血清N末端B型脑钠肽前体(NT-proBNP)和降钙素原(PCT)对急性呼吸窘迫综合征(ARDS)患者严重程度和预后评估的临床价值.方法 选取2015年8月至2016年11月本院呼吸科就诊的急性呼吸窘迫综合症患者51例为研究对象,根据病情严重程度将其分为轻度ARDS(12例)、中度ARDS(26例)、重度ARDS(13例)三组,检测其入院时NT-proBNP和PCT水平;同时根据患者28天死亡情况,将其分为生存组(27例)和死亡组(24例),分析比较两组患者NT-proBNP和PCT水平.通过受试者工作特征曲线(ROC)评价血清NT-proBNP和PCT对ARDS患者预后的诊断价值.结果 ARDS患者的死亡率为47.06％(24/51);轻度、中度ARDS两组患者血清NT-proBNP、PCT水平均显著性低于重度ARDS组(P＜0.05),轻度ARDS组患者血清NT-proBNP、PCT水平显著性低于中度ARDS组(P＜0.05);生存组患者血清NT-proBNP、PCT水平显著性低于死亡组(P＜0.05).ARDS患者血清NT-proBNP、PCT曲线下面积分别为0.832、0.795,灵敏度分别为79.2％,79.2％,特异度分别为74.1％、70.4％.结论 血清NT-proBNP和PCT水平可以预测ARDS患者的预后,但是血清NT-proBNP的效果优于PCT.%Objective To study the clinical value of senun N-terminal pro-brain natriuretic peptide (NT-proBNP) and procalcitonin (PCT) levels in evaluation of severity and outcome in patients with acute respiration distress syndrome (ARDS).Methods From August 2015 to November 2016,51 patients were selected as research object.According to the severity of the disease,they were divided into the mild ARDS group (n =12),the moderate ARDS group (n =26) and the severe ARDS group (n =13).The levels of serum NT-proBNP and PCT were measured.At the same time,they were divided into the survival group (n =27) and the non-survival group (n =24) on the basis of 28-day mortality.Then their serum NT-proBNP and PCT levels were compared between the two groups.ROC curve was used to evaluate the value of NT-proBNP and PCT levels in outcome of patients with ARDS.Results The mortality of patients with ARDS was 47.06％ (24/51).The serum NT-proBNP and PCT were significantly lower in the mild and moderate groups than in the severe ARDS group (P ＜ 0.05),and the levels of serum NT-proBNP and PCT in the mild ARDS group were significantly lower than those in the moderate ARDS group (P ＜ 0.05).The serum levels of NT-proBNP and PCT in the survival group were also significantly lower than those in the death group (P ＜ 0.05).The area under ROC curve (AUC) of NT-proBNP and PCT levels were respectively 0.832 and 0.795.Conclusion The serum levels of NT-proBNP and PCT can predict the prognosis of patients with ARDS,but serum NT-proBNP level is better than PCT.