BNP对AECOPD患者预后评估作用.doc

BNP对AECOPD患者预后评估作用 　【摘要】 目的 研究BNP(B型钠尿肽)对AECOPD(慢性阻塞性肺病急性加重期)患者预后的评估作用。方法 收集2008年1月—2009年1月安庆市立医院呼吸科病房收治的AECOPD患者，对患者进行BNP检测，用BNP水平预测患者收住ICU(重症监护病房)的需要以及1年内的死亡率。结果 COPD患者急性加重期的BNP水平比稳定期明显升高[651，IQR(四分位距)342～1898pg/ml VS 453，IQR 252～854pg/ml，Plt;0.001]。需要收住ICU治疗的患者BNP水平比无需收住ICU的患者明显升高(1052，IQR 666～5535pg/ml VS 609，IQR 311～1690pg/ml，Plt;0.05)。多元Cox回归分析BNP能准确地预测患者收住ICU的需要(危险比1.13，Plt;0.05)。用ROC曲线评价BNP水平对AECOPD患者短期(1个月)和长期(1年)死亡率的预测能力，ROC曲线下面积分别为0.54和0.55。结论 对于AECOPD患者，急性加重期的BNP水平比稳定期明显升高，需要收住ICU治疗的患者BNP水平比无需收住的患者明显升高，BNP能独立预测患者收住ICU的需要，但不能预测患者短期和长期的死亡率。 【关键词】 B型钠尿肽;慢性阻塞性肺病;预后评估 　　[Abstract] Objective To study the role of BNP (B-type natriuretic peptide) in evaluating prognosis of patients with AECOPD (acute exacerbation of chronic obstructive pulmonary disease). Methods Patients with AECOPD were admitted to the respiratory wards of Anqing Municipal Hospital from January 2008 to January 2009. BNP levels were tested for predicting the needs to stay in ICU (intensive care unit) and the mortality within one year. Results BNP levels were significantly higher in patients with acute exacerbation than those in patients with recovery, (651，IQR 342～1898 pg/ml vs 453，IQR 252～854 pg/ml，Plt;0.001).BNP levels in patients needed to stay in ICU were significantly higher than those did not(1052，IQR 666～5535 pg/ml vs 609，IQR 311～1690 pg/ml，Plt;0.05). BNP could accurately predict the needs of ICU stay in Multiple Cox Regression analysis (hazard ratio 1.13, Plt;0.05). The area under the ROC curve were 0.54 and 0.55 respectively evaluating the ability of BNP to predict the short-term (one month) and long-term (one year) mortality with ROC curve.Conclusion For patients with AECOPD, BNP levels were significantly higher in patients with acute exacerbation than those in patients with recovery and significantly higher in patients needed to stay in ICU than in those did not. BNP can accurately and independently predict the needs for ICU stay but can not predict short-term and long-term mortalit