摘要
目的通过前瞻性分析,探讨危重患者血清降钙素原（PCT）及B型钠尿肽（BNP）动态变化水平在医院获得性肺炎（HAP）诊断及预后中的价值。方法收集72例重症监护病房（ICU）发生HAP的患者,另选30例ICU内安全度过围手术期患者作为对照。于确诊HAP当天、第2、第3和第7天检测HAP患者PCT与BNP值,与对照组进行比较,评估2种指标的诊断价值;并根据28 d随访的生存情况将HAP患者分为死亡组（19例）与生存组（53例）,比较2种指标的动态变化,评估其对预后的预测价值。结果 HAP组初始PCT与BNP值均高于对照组（P〈0.05）,对HAP诊断的受试者工作特征（ROC）曲线曲线下面积（AUC）分别为0.627±0.059（95%CI：0.511～0.742,P=0.045）与0.894±0.030（95%CI：0.835～0.954,P=0.000）,灵敏度、特异度、阳性预测值、阴性预测值分别为PCT：65.3%、66.7%、82.5%、44.5%;BNP：72.2%、93.3%、96.3%、58.3%。生存组与死亡组PCT、BNP值确诊当天、第2天差异无统计学意义,但第3、第7天比较差异有统计学意义（P〈0.05）。PCT与BNP的动态变化（ΔPCT、ΔBNP）与ICU住院天数无相关性（P〉0.05）,对预后预测的AUC分别为0.804±0.065（95%CI：0.605～0.861,P=0.003）与0.733±0.065（95%CI：0.677～0.932,P=0.000）,灵敏度、特异度、阳性预测值、阴性预测值分别为ΔPCT：77.4%、78.9%、56.8%、90.7%;ΔBNP：75.5%、68.4%、46.1%、88.6%。结论动态监测PCT与BNP的变化对危重患者HAP的发生及预后预测有一定作用,但价值有限。
Objective To examine the value of serum procalcitonin （PCT） and B-type natriuretic peptide （BNP） in diagnosis and prognosis evaluation of hospital-acquired pneumonia （HAP） in critically ill patients prospectively. Methods A total of 72 critically ill HAP patients were enrolled in intensive care unit （ICU）. Another 30 patients surviving the perioperative period in ICU were taken as control. Serum levels of PCT and BNP were determined on days 1, 2, 3 and 7 after HAP diagnosis and compared with control group. The value of the two indicators for diagnosis of HAP was analyzed by the area under receiver operating characteristic （ROC） curve （AUC）. The HAP patients were assigned to survivor group （n=53） or non-survivor group （n=19） based on 28-day survival state after diagnosis. Dynamic change of PCT and BNP levels （APCT, ABNP） was compared between two groups to assess the value of PCT and BNP change in predicting the prognosis of HAP. Results The initial PCT and BNP levels in HAP group were significantly higher than those in control group （P〈0.05）. The AUC of PCT and BNP were 0.627-0.059 （95% CI： 0.511-0.742, P=0.045）, 0.894~0.030 （95% CI： 0.835-0.954, P=0.000）, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of PCT were 65.3%, 66.7%, 82.5% and 44.5%, respectively; and of BNP were 72.2%, 93.3%, 96.3% and 58.3%, respectively. During the first two days after diagnosis, no significant difference was found beween survivor group and non-survivor group in terms of serum PCT or BNP level, but significant difference was found on Days 3 and 7 （P〈0.05）. There was no significant correlation beween APCT or ABNP and ICU stay （P〉0.05）. The AUC of APCT and ABNP was 0.804_＋0.065 （95% CI： 0.605-0.861, P=-0.003） and 0.733!0.065 （95% CI： 0.677-0.932, P=0.000）, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of APCT were 77.4%, 78.9%, 56.8% and 90.7%, respectively; and of ABNP were 75.5%, 68.4%, 46.1% and 88.6%, respectively. Conclusions Monitoring of the dynamic change of serum PCT and BNP levels only provides limited utility in diagnosis and prognosis evaluation of HAP in critically ill patients.
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2016年第1期5-10,共6页
Chinese Journal of Infection and Chemotherapy
基金
河北省重点科技支撑项目(132777166)
关键词
降钙素原
B型钠尿肽
医院获得性肺炎
受试者工作特征曲线
procalcitonin
B-type natriuretic peptide
hospital-acquired pneumonia
receiver operating characteristic curve
