目的：探讨血浆BNP水平与老年重症肺炎（SP）患者APACHEⅡ评分及预后的相关性。方法：84例老年SP患者为研究对象，检测入院24h内患者的血浆BNP、血气分析、血糖及C反应蛋白（CRP），记录急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ评分），依据住院期间预后、BNP水平及APACHEⅡ评分分为死亡组（n＝54）和存活组（n＝20）、APACHEⅡ评分≥20分组及APACHEⅡ评分＜20分组、BNP≥100 pg／ml组和BNP＜100pg／ml组；比较各组的差异。结果：与存活组比较，死亡组患者BNP、氧合指数、CRP、血糖、APACHEⅡ评分较高（P＜0．05）；APACHEⅡ评分≥20分组患者BNP、病死率高于APACHEⅡ评分＜20分组（P＜0．05）；而BNP≥100 pg／ml组患者APACHEⅡ评分、病死率亦高于BNP＜100pg／ml组（P＜0．05）；Pearson相关分析显示BNP与APACHEⅡ评分呈正相关（r＝0．487，P＜0．05）；多因素Logistic回归分析显示：血浆BNP水平是SP患者住院死亡的高危因素（P＜0．05）；ROC 曲线分析显示：BNP预测SP患者住院死亡的曲线下面积（ROCAUC ）为0．795（95％ C I＝0．536～0．927，P＜0．05），最佳的诊断截点值为284．53pg／ml ，敏感性和特异性分别为77．1％和82．0％。结论：血浆BNP水平与老年SP患者病情严重程度及近期预后密切相关，可能是SP患者近期死亡的独立危险因素，早期检测BNP水平对于评估老年SP患者病情及近期预后具有一定意义。%Objective:To investigate correlation of plasma BNP level between APACHEⅡ and recent prognosis in elderly patients with severe pneumonia (SP) .Methods:84 cases of elderly patients with SP admitted into our hospital from May 2013 to November 2014 were selected as the research subjects ,plasma BNP ,blood gas analy‐sis ,blood sugar and C‐reactive protein (CRP) were detected within 24h ,and acute physiology and chronic health scoreⅡ(APACHEⅡ score) was recorded ,all cases were divided into death group (n=54) and survival group (n=20) ,APACHE Ⅱ score ≥20 group and APACHE Ⅱ score < 20 groups ,BNP≥100 pg/ml group and BNP < 100 pg/ml group on the basis of prognosis of hospitalization ,the BNP levels and APACHE Ⅱ score;and compared the difference between the groups .Results Compared with survival group ,BNP ,CRP ,blood sugar and APACHE Ⅱscore were higher (P <0 .05) ,and oxygenation index was lower (P<0 .05);BNP and mortality of APACHE Ⅱscore ≥20 group were higher than those of APACHE Ⅱ score<20 group (P<0 .05) ,while APACHE Ⅱ score and mortality of BNP ≥100 pg/ml group were higher than those of the BNP<100 pg/ml group (P<0 .05);Pearson correlation analysis showed that BNP positively correlated APACHEⅡ score (r= 0 .487 ,P< 0 .05);multivariable Logistic regression analysis showed that plasma BNP level was high risk factors for hospital death of elderly patients with SP (P< 0 .05);ROC curve analysis showed that :ROCAUC of BNP predicting the death of SP was 0 .795 (95% CI=0 .536~0 .927 ,P<0 .05) ,the best diagnostic cut‐off value was 284 .53pg/ml ,sensitivity and specificity were 77 .1% and 82 .0% respectively .Conclusion:BNP level is closely related to disease severity and prognosis of elderly patients with SP ,and it may be an independent risk factors for death of patients with SP ,early detection of serum phosphorus level play an important role in evaluating disease severity and recent prognosis in elderly patients with SP .
展开▼
