肺超声联合血清NT-proBNP、sFlt-1对急性呼吸窘迫综合征患者病情严重程度及预后评估价值

doi:10.3969/j.issn.1004-583X.2021.12.011

摘要/Abstract

摘要：

目的探讨肺超声联合血清氨基末端脑钠肽前体(NT-proBNP)、可溶性血管内皮生长因子受体(sFlt-1)对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者病情严重程度及预后评估价值。方法选取2018年4月-2020年10月本院收治的ARDS患者138例。按照氧合指数(OI)将ARDS患者分为重度组(OI≤100 mmHg,n=58)、中度组(100 mmHg<OI≤200 mmHg, n=51)、轻度组(200 mmHg<OI≤300 mmHg, n=29),比较3组肺部超声评分(LUS)、血清NT-proBNP、sFlt-1。统计ARDS患者28天病情转归,将ARDS患者分为预后不良组(死亡, n=41)和预后良好组(生存, n=97),对比两组临床资料。采用Logistic回归分析预后相关因素。绘制受试者工作特征曲线(ROC曲线),分析LUS联合NT-proBNP、sFlt-1对ARDS患者预后的诊断价值。结果 3组LUS、血清NT-proBNP、sFlt-1比较,差异有统计学意义(均 P<0.05);重度组LUS、血清NT-proBNP、sFlt-1高于中度组和轻度组(均 P<0.05),中度组LUS、血清NT-proBNP、sFlt-1显著高于轻度组(均 P<0.05);138例ARDS患者中有预后不良41例(29.71%)。Logistic多因素分析显示,入住ICU时间、LUS、NT-proBNP、sFlt-1均为ARDS预后的影响因素(OR=3.943、3.736、3.337、4.289,均 P0.05),ROC曲线显示,LUS联合NT-proBNP、sFlt-1预测ARDS预后的曲线下面积(AUC)为0.896,高于LUS、NT-proBNP、sFlt-1(分别为0.751、0.844、0.773)。结论 LUS联合NT-proBNP、sFlt-1能够评估ARDS患者疾病严重程度,对预后的预测效能较高,可作为临床重要参考指标。

关键词: 呼吸窘迫综合征,成人, 预后, 病人病情, 超声检查

Abstract:

Objective To explore the evaluation value of lung ultrasound combined with serum N-terminal pro-brain natriuretic peptide(NT-proBNP) and soluble vascular endothelial growth factor receptor(sFlt-1) in evaluating the severity and prognosis of acute respiratory distress syndrome(ARDS). Methods Totally 138 ARDS patients were enrolled as the research subjects who treated in our hospital from April 2018 to October 2020. The subjects were classified into severe group (OI≤100 mmHg, 58 cases), moderate group (100 mmHg<OI≤200 mmHg, 51 cases), and mild group (200 mmHg<OI≤300 mmHg, 29 cases) based on oxygenation index (OI). Lung ultrasound score(LUS), serum NT-proBNP, and sFlt-1 levels were compared in groups. The 28-day disease outcome of ARDS patients was counted, and ARDS patients were assigned into a poor prognosis group (death, 41 cases) and a good prognosis group (survival, 97 cases) to compare clinical data between groups. Logistic multivariate regression analysis was used to analyze the prognostic factors. A receiver operating characteristic curve(ROC) was drawn to estimate the diagnostic value of LUS combined with NT-proBNP and sFlt-1 levels on ARDS patients prognosis. Results Difference were statistically different in LUS, serum NT-proBNP, and sFlt-1 levels among three groups (P<0.05), which in the severe group were highest in groups (P<0.05), followed by moderate group, and finally the mild group (all P<0.05). Totally 41 (41/138, 29.71%) cases with poor prognosis involved in 138 ARDS patients, Logistic multivariate analysis showed that influencing factors for ARDS patient prognosis were the length of stay in intensive care unit(ICU), LUS, NT-proBNP level, and sFlt-1 level (OR=3.943, 3.736, 3.337, 4.289, P<0.05), the ROC curve showed that the prognostic AUC of the combination of the three on diagnosis of ARDS was 0.896, which was higher than the AUC of LUS, NT-proBNP, and sFlt-1 alone (0.751, 0.844, 0.773). Conclusion For ARDS patients, the combination of the three can assess the severity, and has a high diagnostic efficiency for the prognosis; therefore, it can be used as an important clinical reference index.

Key words: respiratory distress syndrome, adult, prognosis, patient acuity, ultrasonography

中图分类号:

R563.8

马桂兰, 敏菊. 肺超声联合血清NT-proBNP、sFlt-1对急性呼吸窘迫综合征患者病情严重程度及预后评估价值[J]. 临床荟萃, 2021, 36(12): 1110-1113.

Ma Guilan, Min Ju. Evaluation value of severity and prognosis of Lung ultrasound combined with serum NT-proBNP and sFlt-1 on acute respiratory distress syndrome in patient[J]. Clinical Focus, 2021, 36(12): 1110-1113.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.011

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1110

图/表 5

参考文献 15

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组别	例数	LUS (分)	NT-proBNP (pg/mL)	sFlt-1 (ng/L)
重度组	58	24.82±4.47	819.31±72.17	603.57±58.49
中度组	51	18.43±3.86^*	729.46±62.47^*	526.78±47.25^*
轻度组	29	12.10±3.15^*#	522.28±70.16^*#	417.32±53.21^*#
F值		102.316	183.092	118.523
P值		<0.01	<0.01	<0.01

组别	例数	LUS (分)	NT-proBNP (pg/mL)	sFlt-1 (ng/L)
重度组	58	24.82±4.47	819.31±72.17	603.57±58.49
中度组	51	18.43±3.86^*	729.46±62.47^*	526.78±47.25^*
轻度组	29	12.10±3.15^*#	522.28±70.16^*#	417.32±53.21^*#
F值		102.316	183.092	118.523
P值		<0.01	<0.01	<0.01

项目	预后不良组 (n=41)	预后良好组 (n=97)	统计值	P值
性别[例(%)]
男女	27(65.85) 14(34.15)	55(56.70) 42(43.30)	χ²=0.193	0.660
年龄(岁)	57.10±7.93	55.83±8.12	t=0.845	0.399
BMI(kg/m²)	22.53±2.72	22.31±2.61	t=0.447	0.656
入住ICU时间(天)	14.20±2.36	11.15±1.72	t=8.482	<0.01
既往史[例(%)]
冠心病史	5(12.20)	11(11.34)	χ²=0.021	0.886
糖尿病史	6(14.63)	9(9.28)	χ²=0.853	0.356
高血压史	9(21.95)	17(17.53)	χ²=0.369	0.543
高血脂症史	8(19.51)	15(15.46)	χ²=0.340	0.560
吸烟史	13(31.70)	24(24.74)	χ²=0.712	0.399
饮酒史	10(24.39)	21(21.65)	χ²=0.124	0.724
呼吸频率(次/min)	25.48±3.24	24.71±3.05	t=1.330	0.186
发病原因[例(%)]
脓毒血症	16(39.02)	36(37.11)
脑血管事件	9(21.95)	22(22.68)	χ²=0.052	0.997
外伤	8(19.51)	20(20.62)
开胸术后	8(19.51)	19(19.59)
MAP(mmHg)	69.27±10.21	72.52±9.71	t=1.770	0.079
PEEP(cmH₂O)	12.57±3.76	11.92±3.57	t=0.962	0.338
PaCO₂(mmHg)	36.18±6.64	39.53±6.97	t=2.616	0.010
PaO₂(mmHg)	69.49±8.06	72.87±8.56	t=2.156	0.033
OI(mmHg)	115.06±9.17	157.96±13.79	t=18.266	<0.01
LUS(分)	24.98±4.83	17.11±3.76	t=16.841	<0.01
NT-proBNP(pg/mL)	821.73±62.97	546.85±51.76	t=26.687	<0.01
sFlt-1(ng/L)	605.17±49.84	451.43±50.32	t=16.448	<0.01

项目	预后不良组 (n=41)	预后良好组 (n=97)	统计值	P值
性别[例(%)]
男女	27(65.85) 14(34.15)	55(56.70) 42(43.30)	χ²=0.193	0.660
年龄(岁)	57.10±7.93	55.83±8.12	t=0.845	0.399
BMI(kg/m²)	22.53±2.72	22.31±2.61	t=0.447	0.656
入住ICU时间(天)	14.20±2.36	11.15±1.72	t=8.482	<0.01
既往史[例(%)]
冠心病史	5(12.20)	11(11.34)	χ²=0.021	0.886
糖尿病史	6(14.63)	9(9.28)	χ²=0.853	0.356
高血压史	9(21.95)	17(17.53)	χ²=0.369	0.543
高血脂症史	8(19.51)	15(15.46)	χ²=0.340	0.560
吸烟史	13(31.70)	24(24.74)	χ²=0.712	0.399
饮酒史	10(24.39)	21(21.65)	χ²=0.124	0.724
呼吸频率(次/min)	25.48±3.24	24.71±3.05	t=1.330	0.186
发病原因[例(%)]
脓毒血症	16(39.02)	36(37.11)
脑血管事件	9(21.95)	22(22.68)	χ²=0.052	0.997
外伤	8(19.51)	20(20.62)
开胸术后	8(19.51)	19(19.59)
MAP(mmHg)	69.27±10.21	72.52±9.71	t=1.770	0.079
PEEP(cmH₂O)	12.57±3.76	11.92±3.57	t=0.962	0.338
PaCO₂(mmHg)	36.18±6.64	39.53±6.97	t=2.616	0.010
PaO₂(mmHg)	69.49±8.06	72.87±8.56	t=2.156	0.033
OI(mmHg)	115.06±9.17	157.96±13.79	t=18.266	<0.01
LUS(分)	24.98±4.83	17.11±3.76	t=16.841	<0.01
NT-proBNP(pg/mL)	821.73±62.97	546.85±51.76	t=26.687	<0.01
sFlt-1(ng/L)	605.17±49.84	451.43±50.32	t=16.448	<0.01

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
入住ICU时间	1.372	0.361	14.444	0.015	3.943	1.362	6.524
LUS	1.318	0.312	17.845	0.002	3.736	2.631	4.841
NT-proBNP	1.205	0.297	16.461	0.006	3.337	2.776	3.898
sFlt-1	1.456	0.307	22.493	<0.01	4.289	2.283	6.295