机械通气辅助治疗的呼吸衰竭患者N末端脑钠肽前体的变化及临床意义

目的 探讨机械通气辅助治疗的呼吸衰竭患者N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide, NT-proBNP）浓度变化特点,评估血清NT-proBNP浓度检测的临床意义.方法 回顾性分析201 1年至2012年因呼吸衰竭而于韶关粤北人民医院重症监护病房（intensive care unit,ICU）住院治疗的患者共43例,采用电化学发光免疫分析法监测患者血清NT-proBNP浓度,同时检测并记录体温峰值、红细胞沉降率、白细胞计数、中性粒细胞比值、C反应蛋白、降钙素原、心功酶、心肌肌钙蛋白T、左心室射血分数、中心静脉压、住院时间等指标.入选患者根据NT-proBNP分为明显升高组（NT-proBNP＞9 000 pg/mL）21例,普通升高组（1 000 pg/mL ＜NT-proBNP＜9 000 pg/mL）22例.探讨血清NT-proBNP浓度对于评估患者炎症状态,心脏功能及住院时间的临床价值.结果 血清NT-proBNP浓度明显升高组（A组）与NT-proBNP普通升高组（B组）相比较,体温峰值、红细胞沉降率、白细胞计数、中性粒细胞比值、C反应蛋白、降钙素原、ICU住院时间和中心静脉压均显著升高,差异有统计学意义（P＜0.05）.血清NT-proBNP浓度与体温峰值（r=0.663,P＜0.001）、红细胞沉降率（r=0.583,P＜0.001）、C反应蛋白（r=0.637,P＜0.001）、白细胞计数（r=0.659,P＜0.001）、中性粒细胞比值（r=0.748,P＜0.001）、降钙素原（r=0.638,P＜0.001）、住院时间（r=0.658,P＜0.001）、中心静脉压（r=0.595,P＜0.001）、心肌肌钙蛋白T（r=0.350,P=0.019）呈正相关.两组间血气分析结果比较,差异无统计学意义（P＞0.05）.结论 血清NT-proBNP浓度与机械通气辅助治疗的呼吸衰竭患者的感染严重程度以及心脏功能相关,可作为病情监测的有效标志物.

Role of detection of N-terminal pro-brain natriuretic peptide for patients with respiratory failure using mechanical ventilator

Objectives To investigate the characteristics of changes in the concentration of N-terminal pro-brain natriuretic peptide （NT-proBNP） in patients with lung failure using mechanical ventilator,and to estimate the clinical significance of NT-proBNP.Methods Totally 43 participants who were suffered from respiratory failure in the intensive care unit （ICU） of Yue Bei People＇s Hospital from 2011 to 2012 had been included in this retrospective analysis.Data of NT-proBNP,peak body temperature,erythrocyte sedimentation rate （ESR）,white blood cell （WBC） count,neutrophil （NEUT）,C-reactive protein （CRP）,procalcitonin （PCT）,cardiac enzyme,cardiac troponin T （cTnT）,left ventricular ejection fraction,central venous pressure,duration of hospitalization in ICU and other markers were recorded by electrochemiluminescence （ECL）analysis.All the patients were divided into two groups according to the concentration of NT-proBNP：group A （NT-proBNP〉9 000 pg/mL,21 patients） and group B （1 000 pg/mL〈NT-proBNP〈9 000 pg/mL,22 patients）.Differences in all markers between the two groups were compared.Results Significant differences had been found between the two groups in peak body temperature,ESR,WBC count,NEUT,CRP,PCT,duration of hospitalization in ICU and central venous pressure （P〈0.05）.A positive correlation has been found between NT-proBNP and peak body temperature （r=0.663,P〈0.001）,ESR （r=0.583,P〈0.001）,CRP （r=0.637,P〈0.001）,WBC count （r=0.659,P〈0.001）,NEUT （r=0.748,P〈0.001）,PCT （r=0.638,P〈0.001）,duration of hospitalization in ICU （r=0.658,P〈0.001）,central venous pressure （r=0.595,P〈0.001） and cTnT （r=0.350,P=0.019）.No significant differences of blood gas test had been found between the two groups （P〉0.05）.Conclusions Serum concentration of NT-proBNP has a correlation with the severity of infection and heart function in patients with respiratory failure using mechanical ventilator,which can be an effective marker for det