摘要
目的探究6 h乳酸清除率联合N末端脑钠肽前体(NT-proBNP)、白蛋白(ALB)检测对老年重症肺炎患者预后评估的价值。方法回顾性分析2018年9月至2020年9月北京电力医院重症加强护理病房(ICU)收治的老年重症肺炎患者110例作为研究对象,根据预后28 d生存情况分为存活组(62例)和死亡组(48例)。收集受试者血乳酸水平,并根据公式计算6 h乳酸清除率,酶联免疫吸附法(ELISA)检测受试者血清NT-proBNP的水平,溴甲酚绿法检测受试者血清ALB的水平。二元Logistic回归分析老年重症肺炎患者发生死亡的影响因素。受试者工作特征曲线(ROC)分析6 h乳酸清除率、血清NT-proBNP及ALB对老年重症肺炎患者发生死亡的预测价值。结果与存活组比较,死亡组6 h乳酸清除率、血清ALB水平降低(P<0.05),血清NT-proBNP水平升高(P<0.05)。二元Logistic回归分析显示,6 h乳酸清除率(OR=2.035,95%CI:1.511~2.741)、血清ALB水平偏低(OR=2.132,95%CI:1.662~2.735)及血清NT-proBNP水平偏高(OR=2.671,95%CI:2.182~3.493)是老年重症肺炎患者发生死亡的危险因素(P均<0.05)。ROC分析显示,6 h乳酸清除率预测老年重症肺炎患者发生死亡的曲线下面积(AUC)为0.789(95%CI:0.703~0.874);血清NT-proBNP预测老年重症肺炎患者发生死亡的AUC为0.762(95%CI:0.671~0.853);血清ALB预测老年重症肺炎患者发生死亡的AUC为0.726(95%CI:0.628~0.825);三者联合检测预测老年重症肺炎患者发生死亡的AUC为0.900(95%CI:0.843~0.957)。结论老年重症肺炎患者6 h乳酸清除率、血清ALB水平降低,血清NT-proBNP水平升高,联合检测对老年重症肺炎患者发生死亡事件具有较高预测价值,可能作为预测老年重症肺炎患者发生死亡的标志物。
ObjectiveTo evaluate the value of 6-hour lactate clearance combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)and albumin(ALB)in the prognostic evaluation of elderly patients with severe pneumonia.MethodsA retrospective analysis was performed on 110 elderly patients with severe pneumonia admitted to the intensive care unit(ICU)of Beijing Electric Power Hospital from September 2018 to September 2020.According to the 28-day prognosis,the patients were divided into either a survival group(62 cases)or a death group(48 cases).Blood lactic acid levels of the subjects were collected,and the 6-hour lactic acid clearance rate was calculated.Enzyme-linked immunosorbent assay(ELISA)was used to detect the level of serum NT-proBNP in subjects,and bromocresol green method was used to detect the level of serum ALB in subjects.Binary logistic regression was used to analyze the influencing factors of death in elderly patients with severe pneumonia.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of 6-hour lactate clearance rate,serum NT-proBNP,and ALB for the death of elderly patients with severe pneumonia.ResultsCompared with the survival group,the 6-hour lactic acid clearance rate and serum ALB level significantly decreased in the death group(P<0.05),and the serum NT-proBNP level significantly increased(P<0.05).Binary logistic regression analysis showed that the 6-hour lactate clearance rate(OR=2.035,95%CI:1.511~2.741),low serum ALB level(OR=2.132,95%CI:1.662~2.735),and high serum NT-proBNP level(OR=2.671,95%CI:2.182~3.493)were risk factors for death in elderly patients with severe pneumonia(P<0.05 each).ROC analysis showed that the area under the ROC curve(AUC)of 6-hour lactate clearance for predicting death was 0.789(95%CI:0.703~0.874),and the AUCs of serum NT-proBNP and serum ALB were 0.762(95%CI:0.671~0.853)and 0.726(95%CI:0.628~0.825),respectively.The AUC of combined detection of 6-hour lactate clearance with serum NT-proBNP and ALB was 0.900(95%CI:0.843~0.957).ConclusionIn elderly patients with severe pneumonia,the 6-hour lactate clearance rate and serum ALB level decrease and serum NT-proBNP level increases.Combined detection of the three indices has high predictive value for death in elderly patients with severe pneumonia,and may be used as a marker to predict the death in this group of patients.
作者
王婷
李海明
李红梅
Wang Ting;Li Haiming;Li Hongmei(Department of Respiratory Medicine,Electric Power Teaching Hospital of Capital Medical University,Beijing 100073,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2021年第12期954-959,共6页
Chinese Journal of Clinicians(Electronic Edition)
关键词
重症肺炎
6
h乳酸清除率
N末端脑钠肽前体
白蛋白
Severe pneumonia
6-hour lactate clearance rate
N-terminal pro-brain natriuretic peptide
Albumin
作者简介
通信作者:李红梅,Email:lihomgmei309@163.com
