| 摘要: |
| ［摘要］ 目的 探讨N-末端脑钠肽前体（NT-proBNP）在慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease，AECOPD)预后评估中的价值。方法 收集广州医科大学附属第三医院呼吸内科收治的检测有NT-proBNP的AECOPD患者193例的临床资料。根据患者出院时的存活状态分为存活组和死亡组，通过绘制受试者特征曲线（ROC曲线）计算确定患者住院死亡的NT-proBNP的界值及敏感度、特异度。通过单因素分析和Logistic回归分析来确定患者住院死亡的危险因素。结果 193例患者中，存活173例，死亡20例，病死率为10.4%。死亡组NT-proBNP为（7 040±10 150）pg/ml，高于存活组的（2 147±4 774）pg/ml，P<0.001。ROC曲线显示确定患者住院死亡的NT-proBNP值为1 249.5 pg/ml，曲线下面积为0.804(95%CI=0.730～0.879），其敏感度为80.0%，特异度为71.1%。单因素分析显示血清尿素氮>7.14 mmol/L、白细胞计数≥10×109/L、NT-proBNP≥1 249.5 pg/ml、慢性心功能不全合并症、全血中性粒细胞比例≥80%以及患者体重指数（BMI）降低是患者住院死亡的危险因素。Logistic回归分析显示NT-proBNP≥1 249.5 pg/ml（OR=7.68，95%CI=1.72～34.38）、慢性心功能不全合并症（OR=3.96，95%CI=1.02～15.40）、全血中性粒细胞比例≥80%（OR=21.47，95%CI=2.42～190.40）是患者住院死亡的危险因素；而患者BMI增加是住院死亡的保护性因素（OR=0.2，95%CI=0.06～0.63）。结论 NT-proBNP升高是AECOPD患者住院死亡独立危险因素。 |
| 关键词: 慢性阻塞性肺疾病急性加重期 N-末端脑钠肽前体 死亡 预后 |
| DOI：10.3969/j.issn.1674-3806.2017.09.01 |
| 分类号:R 563 |
| 基金项目:国家自然科学基金资助项目（编号：81670042）；广东省医学科学技术研究基金项目（编号：A2016265） |
|
| Prediction value of NT-proBNP for the mortality of the inpatients with acute exacerbation of chronic obstructive pulmonary disease |
|
HU Guo-ping, LI Yu-qun, WU Ze-long, et al.
|
|
Department of Respiratory Medicine, the Third Affiliated Hospital of Guangzhou Medical University, Guangdong 510150, China
|
| Abstract: |
| ［Abstract］ Objective To investigate the prediction value of N-terminal pro-brain natriuretic protein(NT-proBNP) for the mortality of the inpatients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The clinic data of 193 AECOPD patients whose values of NT-proBNP had been examined were collected. All the patients were divided into the survival group and the death group according to the survival status at the time of discharge from the hospital. A receiver-operator-curve(ROC) analysis was used to determine the level of NT-proBNP that discriminated survivors from non-survivors. Univariate analysis and multiple logistic regression analyses were used to identify the risk factors of in-hospital mortality.Results During the patients′ hospitalization, 20 cases died and 173 cases survived. The death group had a higher level of NT-proBNP than the survival group ［(7 040±10 150）pg/ml vs （2 147±4 774）pg/ml, P<0.001］. The area under the ROC curve for the NT-proBNP prediction of death was 0.804(95%CI: 0.730～0.879). The value of NT-proBNP discriminating survivors from non-survivors was 1 249.5 pg/ml, with a sensitivity being 80.0% and a specitity being 71.1%. Univariate analysis showed that blood urea nitrogen(BUN )>7.14 mmol/L, blood cell （WBC）≥10×109/L, NT-proBNP≥1 249.5 pg/ml, the propotion of neutrophils(N%)≥80%, body mass index(BMI) and the comorbidy of chronic heart failure were the risk factors of in-hospital mortality. Multiple logistic regression analysis showed that N% >80%(OR=21.47.95%CI=2.42～190.40), NT-proBNP>1 249.5 pg/ml(OR=7.68, 95%CI=1.72～34.38) and heart failure(OR=3.96, 95%CI=1.02～15.40) were the independent risk factors of in-hospital mortality of AECOPD, and that increasing BMI was a protective factor of in-hospital mortality of AECOPD.Conclusion The elevated level of NT-proBNP is a strongly independent risk factor of mortality in the AECOPD inpatients. |
| Key words: Acute exacerbation of chronic obstructive pulmonary disease(AECOPD) N-terminal pro-brain natriuretic protein(NT-proBNP) Mortality Prognosis |
