摘要
目的:探讨血清胆碱酯酶(CHE)、氨基末端-B型脑利钠肽前体(NT-proBNP)、降钙素原(PCT)应用于心衰伴肺部感染患者诊断与预后评估的临床价值。方法:回顾性分析120例心衰伴肺部感染患者临床资料,分别根据纽约心脏病协会(NYHA)心功能分级及28d生存情况分为Ⅱ级组(n=42)、Ⅲ级组(n=49)、Ⅳ级组(n=29)及死亡组(n=23)与存活组(n=97),另将162例单纯心衰患者临床资料纳入对照。比较不同病情与预后患者血清CHE、NT-proBNP、PCT水平差异,以Spearman相关系数模型分析上述指标与心功能的相关性,以受试者工作特征(ROC)曲线分析上述指标预测心衰伴肺部感染患者28d生存情况的诊断学效能。结果:伴肺部感染的心衰患者血清CHE水平明显低于不伴肺部感染心衰患者,而血清NT-proBNP、PCT水平则明显高于不伴肺部感染心衰患者(P<0.05)。不同心功能心衰伴肺部感染患者中,血清CHE水平Ⅱ级组>Ⅲ级组>Ⅳ级组,血清NT-proBNP、PCT水平Ⅱ级组<Ⅲ级组<Ⅳ级组(P<0.05)。血清CHE水平与心衰伴肺部感染患者心功能呈显著负相关性(r<0,P<0.05),而血清NT-proBNP、PCT水平与其心功能呈显著正相关性(r>0,P<0.05)。死亡组患者血清CHE水平明显低于存活组,而血清NT-proBNP、PCT水平均明显高于存活组(P<0.05)。CHE、NT-proBNP、PCT预测心衰伴肺部感染患者28d死亡的ROC曲线AUC均明显小于联合预测(P<0.05),截断值分别为4.18kU/L、11.61μg/L、10.04μg/L。结论:血清CHE、NT-proBNP、PCT水平与心衰伴肺部感染患者预后关系甚为密切,临床早期联合检测有助于为诊治方案提供指导,以期尽早采取相应干预措施改善其预后。
Objective: To explore the clinical value of serum cholinesterase(CHE), N-terminal pro-brain natriuretic peptide(NT-proBNP) and procalcitonin(PCT) on diagnosis and prognosis assessment of patients with heart failure and pulmonary infection. Methods: The clinical data of 120 patients with heart failure and pulmonary infection were retrospectively analyzed. According to the New York Heart Association(NYHA) cardiac function grading and 28 d survival, they were divided into grade II group(n=42), grade III group(n= 49) and grade IV group(n=29) and death group(n=23) and survival group(n=97), and the clinical data of 162 patients with simple heart failure were included in controls. The levels of serum CHE, NT-proBNP and PCT were compared among patients with different disease condition and prognosis. The correlation between the above indexes and cardiac function was analyzed by Spearman correlation coefficient model. Receiver operating characteristic(ROC) curves were used to analyze the diagnostic efficacy of the above indexes in predicting 28 d survival of patients with heart failure and pulmonary infection. Results: Serum CHE level in patients with heart failure and pulmonary infection was significantly lower than that of patients without pulmonary infection while the levels of serum NT-proBNP and PCT were significantly higher than those of patients without pulmonary infection(P<0.05). Among patients with heart failure and pulmonary infection with different cardiac function, serum CHE level showed grade II group> grade III group> grade IV group, and the levels of serum NT-proBNP and PCT showed grade II group< grade III group< grade IV group(P<0.05). Serum CHE level was significantly negatively correlated with cardiac function in patients with heart failure and pulmonary infection(r<0, P<0.05) while levels of serum NT-proBNP and PCT were significantly positively correlated with cardiac function(r>0, P<0.05). Serum CHE level in death group was significantly lower than that in survival group while levels of serum NT-proBNP and PCT were significantly higher than those in survival group(P<0.05). The AUC values of ROC curves of CHE, NT-proBNP and PCT in predicting 28 d death of patients with heart failure and pulmonary infection were significantly smaller than those of combination prediction(P<0.05), and the cut-off values were 4.18 kU/L, 11.61 μg/L and 10.04 μg/L respectively. Conclusion: Serum CHE, NT-proBNP and PCT levels are closely related to the prognosis of patients with heart failure and pulmonary infection. Early clinical combination testing can help guide the diagnosis and treatment plan, so as to take appropriate intervention measures to improve the prognosis as soon as possible.
作者
陈公海
颜光寰
王光权
CHEN Gonghai;YAN Guanghuan;WANG Guangquan(Qionghai People's Hospital, Hainan Qionghai 571400, China)
出处
《河北医学》
CAS
2019年第12期1937-1941,共5页
Hebei Medicine
基金
海南省卫生健康科研项目,(编号:14A200023)
关键词
心衰
肺部感染
胆碱酯酶
氨基末端-B型脑利钠肽前体
降钙素原
Heart failure
Pulmonary infection
Cholinesterase
N-terminal pro-brain natriuretic peptide
Procalcitonin
