使用基于 N 端脑利钠肽前体（NT-pro BNP）的评分预测心力衰竭患者的心源性肺水肿。

Predicting cardiogenic pulmonary edema in heart failure patients by using an N-terminal pro-b-type natriuretic peptide (NT-pro BNP) -based score.

机构信息

Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan, ROC.

Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan, ROC; Department of Nursing, Saint Mary's Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan, ROC.

出版信息

Clin Chim Acta. 2018 May;480:26-33. doi: 10.1016/j.cca.2018.01.042. Epub 2018 Feb 20.

DOI:10.1016/j.cca.2018.01.042

PMID:29408167

Abstract

BACKGROUND

Cardiogenic pulmonary edema (CPE) is a life-threatening emergency necessitating aggressive management. We conducted this study to test the hypothesis that a combination of N-terminal pro-b-type natriuretic peptide (NT-pro-BNP) and some relevant clinical factors may provide better predictability for CPE in heart failure (HF) patients.

METHODS

This retrospective study enrolled adult HF patients hospitalized during January 2011 to December 2013. After determining the independent predictors for the occurrence of CPE, a novel NT-pro BNP-based diagnostic score for predicting CPE was established.

RESULTS

A total of 269 patients (mean age, 74.5 ± 13.6 years; female, 53.9%) were enrolled, and categorized into CPE group (n = 80, 29.7%) and non-CPE group (n = 189, 70.3%). Several factors such as "Serum NT-pro-BNP level > 6980 mg/dl," "systemic blood pressure > 170 mm Hg," "heart rate > 120 bpm," "with rales in breathing sound," "with jugular vein engorgement," "with NYHA Fc III/IV," "with chronic lung disease" and "with angiotensin converting enzyme inhibitors/angiotensin receptor blocker" were found to be associated with the existence of CPE. A novel NT-pro BNP based scoring system containing these risk factors was proposed and proven excellent in predicting CPE.

CONCLUSIONS

The NT-pro-BNP scoring system could predict CPE in HF patients.

摘要

背景

心源性肺水肿（CPE）是一种危及生命的紧急情况，需要积极治疗。我们进行这项研究是为了验证一个假设，即脑钠肽前体 N 端（NT-pro-BNP）与一些相关临床因素的组合可能为心力衰竭（HF）患者的 CPE 提供更好的预测性。

方法

这项回顾性研究纳入了 2011 年 1 月至 2013 年 12 月期间住院的成年 HF 患者。在确定了发生 CPE 的独立预测因素后，建立了一种新的基于 NT-pro BNP 的诊断评分来预测 CPE。

结果

共纳入 269 例患者（平均年龄 74.5±13.6 岁；女性 53.9%），分为 CPE 组（n=80，29.7%）和非 CPE 组（n=189，70.3%）。一些因素，如“血清 NT-pro-BNP 水平>6980mg/dl”、“全身血压>170mmHg”、“心率>120bpm”、“呼吸音有啰音”、“颈静脉充盈”、“纽约心脏协会心功能分级 III/IV 级”、“慢性肺部疾病”和“血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂”与 CPE 的存在有关。提出了一种新的基于 NT-pro-BNP 的评分系统，包含这些危险因素，且证明其在预测 CPE 方面具有优异的性能。