摘要
目的:探讨慢性心衰合并肺部感染(Chronic heart failure combined with pulmonary infection,CHF-PI)患者血清氨基末端脑钠肽前体(N-terminal brain natriuretic peptide precursor,NT-proBNP)、降钙素原(Procalcitonin,PCT)、淀粉酶样蛋白A(Serum amyloid A,SAA)水平变化,并分析其与肺部感染程度相关性及其对预后的预测价值。方法:回顾性选取2021年1月~2023年12月于本院诊治的CHF-PI患者110例为合并组,另选取同期未合并肺部感染的CHF患者55例作为未合并组。比较两组临床资料及血清NT-proBNP、PCT、SAA水平。依据肺部感染程度将合并组分为低危44例、中危38例、高危28例,比较其血清NT-proBNP、PCT、SAA水平。多因素Logistic回归分析CHF-PI发生的影响因素。分析血清NT-proBNP、PCT、SAA与影响因素、肺部感染程度相关性。合并组经常规治疗,依据治疗后6m预后情况分为预后不良亚组41例、预后良好亚组69例,比较其血清NT-proBNP、PCT、SAA水平,并分析其对预后的预测价值。结果:合并组血清NT-proBNP、PCT、SAA水平高于未合并组(P<0.05);肺部感染程度高危者血清NT-proBNP、PCT、SAA水平>中危>低危(P<0.05);中性粒细胞百分比、淋巴细胞百分比、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、乳酸脱氢酶(lactate dehydrogenase,LDH)、肌钙蛋白I(Cardiac Troponin I,cTnI)、NT-proBNP、PCT、SAA为CHF-PI发生的独立危险因素(P<0.05);NT-proBNP、PCT、SAA与中性粒细胞百分比、淋巴细胞百分比、CK-MB、LDH、cTnI、肺部感染程度呈正相关(P<0.05);预后不良亚组治疗后血清NT-proBNP、PCT、SAA水平高于预后良好亚组(P<0.05);治疗后2m血清NT-proBNP、PCT、SAA水平联合预测治疗后6m预后的AUC大于单项指标预测(P<0.05)。结论:CHF-PI患者血清NT-proBNP、PCT、SAA水平升高,其与心肌损伤、肺感染程度呈正相关,且为CHF-PI发生的独立危险因素,联合检测可为预后预测提供参考。
Objective:To investigate Chronic heart failure combined with pulmonary infection(CHF-PI)patients,Serum N-terminal brain natriuretic peptide precursor(NT-proBNP),Procalcitonin(PCT)and Serum amyloid A(SAA)levels were analyzed to evaluate their correlation with the degree of pulmonary infection and their prognostic value.Methods:A total of 110 CHF-PI patients treated in our hospital from January 2021 to December 2023 were selected as the combined group,and 55 CHF patients without pulmonary infection during the same period were selected as the non-combined group.The clinical data and serum levels of NT-proBNP,PCT and SAA were compared between the two groups.According to the degree of pulmonary infection,the combined group was divided into low-risk 44 cases,medium-risk 38 cases and high-risk 28 cases,and the serum levels of NT-proBNP,PCT and SAA were compared.The influencing factors of CHF-PI were analyzed by Logistic regression.The correlation of serum NT-proBNP,PCT,SAA with influencing factors and degree of pulmonary infection was analyzed.After conventional treatment,the combined group was divided into 41 subgroups with poor prognosis and 69 subgroups with good prognosis after 6 months of treatment.The levels of serum NT-proBNP,PCT and SAA were compared,and their predictive value for prognosis was analyzed.Results:The levels of serum NT-proBNP,PCT and SAA in the combined group were higher than those in the non-combined group(P<0.05).The levels of serum NT-proBNP,PCT and SAA in high risk patients were>medium risk>low risk(P<0.05).Percentage of neutrophils,percentage of lymphocytes,creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),Cardiac Troponin I,(cTnI),NT-proBNP,PCT and SAA were independent risk factors for CHF-PI(P<0.05).NT-proBNP,PCT and SAA were positively correlated with neutrophil percentage,lymphocyte percentage,CK-MB,LDH,cTnI and lung infection degree(P<0.05).The levels of serum NT-proBNP,PCT and SAA in the poor prognosis subgroup were higher than those in the good prognosis subgroup(P<0.05).The
作者
李玉玮
王晓燕
葛茹
Li Yu-wei;Wang Xiao-yan;Ge Ru(Department of Medical Laboratory,The Third People's Hospital of Puyang,Puyang 457000,Henan,China;Department of Medical Laboratory,Puyang Oilfield General Hospital,Puyang 457000,Henan,China)
基金
河南省医学科技攻关联合共建项目(编号:LHGJ20221106)。
关键词
慢性心力衰竭
肺部感染
氨基末端脑钠肽前体
降钙素原
淀粉酶样蛋白A
Chronic heart failure
Lung infection
Amino-terminal brain natriuretic peptide precursor
Procalcitonin
Amylase-like protein A
