N末端B型利钠肽原在老年CAP患者病情和治疗效果评估中的价值

目的 探讨N末端B型利钠肽原(N-terminal B-type natriuretic peptide, NT-proBNP)在老年社区获得性肺炎(community acquired pneumonia, CAP)病情严重程度和疗效评估中的价值。方法 选择同济大学附属同济医院2014年1月至2015年12月老年(年龄≥60岁)CAP 120例作为肺炎组,老年健康者120例作为对照组。肺炎组患者根据CURB-65评分分为低危组(51例)、中危组(40例)和高危组(29例)。抽取两组患者外周静脉血,测定NT-proBNP、C-反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin,PCT)水平和白细胞计数。结果 肺炎组患者NT-proBNP、CRP、PCT水平和白细胞计数均明显高于对照组患者(P<0.05)。高危组患者NT-proBNP、CRP、PCT水平和白细胞计数高于中危组和低危组(P<0.05),中危组NT-proBNP、CRP、PCT水平和白细胞计数高于低危组(P<0.05)。老年肺炎肺炎严重指数(pneumonia severity index,PSI)评分与NT-proBNP、CRP、PCT水平和白细胞计数均呈正相关(P<0.05)。肺炎组患者治疗后NT-proBNP、CRP水平和白细胞计数低于治疗前(P<0.05),PCT水平和治疗前比较,差异没有统计学意义(P>0.05)。结论 血清NT-proBNP水平在老年CAP患者病情严重程度和治疗效果的评价中具有重要意义。
Objective To investigate the value of N-terminal B-type natriuretic peptide (NT-proBNP) in evaluation of disease severity and therapeutic efficacy in elderly patients with community-acquired pneumonia. Methods One hundred and twenty patients aged ≥60 years with community-acquired pneumonia were enrolled from January 2014 to December 2015, and another 120 elderly healthy subjects served as control group. Among 120 pneumonia patients 51 cases was in low-risk group, 40 in moderate risk group and 29 in high-risk group according to their CURB-65 scores. The serum NT-proBNP, C- reactive protein (CRP), procalcitonin (PCT) levels and white blood cell (WBC) counts were measured. Results The serum NT-proBNP, CRP, PCT levels and WBC counts in pneumonia patients were significantly higher than those in control group (all P<0.05). The NT-proBNP, CRP, PCT levels and WBC counts in high-risk group were higher than those in moderate risk and low-risk groups (P<0.05); the above parameters in moderate risk group were higher than those in low risk group (P<0.05). The pneumonia severity index (PSI) scores of patients were positively correlated with the NT-proBNP, CRP, PCT levels and WBC counts (P<0.05). The NT-proBNP, CRP levels and WBC counts after treatment were lower than those before treatment in the pneumonia patients (P <0.05), but the changes of PCT level were not statistically significant (P>0.05). Conclusion The serum NT-proBNP level can be used for evaluation of disease severity and treatment effectiveness in elderly patients with community-acquired pneumonia