标题：心力衰竭合并重症细菌性肺炎患者BNP、CRP、PCT的变化及其临床意义

      作者：孟仙梅 1，林红飞 2，黎璞 3    (1.西安高新医院重症医学科，陕西 西安 710075；2.宝鸡市第三人民医院呼吸内科，陕西 宝鸡 721006；3.空军军医大学第二附属医院重症监护中心，陕西 西安 710038)

      卷次： 2018年29卷24期

      【摘要】 目的 观察心力衰竭合并重症细菌性肺炎患者B型脑钠肽(BNP)、C-反应蛋白(CRP)和降钙素原(PCT)水平的变化并探讨其临床意义。方法 选取2011年2月至2018年2月在西安高新医院诊治的心力衰竭合并细菌性肺炎患者212例、非感染性心力衰竭患者80例以及健康体检者60例为研究对象，检测并比较各组受检者血液中的BNP、CRP、PCT水平。结果 心力衰竭合并细菌性肺炎患者中67例为重症肺炎，占31.60%，其中70岁以上患者所占比例(40.28%)明显高于70岁以下患者(27.14%)，夏季发病率(14.81%)明显低于春(32.26%)、秋(31.03%)、冬(38.46%)三季，差异均有统计学意义(P<0.05)；心力衰竭合并重症肺炎、合并非重症肺炎、单纯心力衰竭及对照组的BNP分别为(582.64±91.07) ng/L、(417.06±81.37) ng/L、(252.64±72.82) ng/L和(69.28±6.15) ng/L，PCT分别为(5.11±1.08) ng/mL、(3.82±0.68) ng/mL、(2.12±0.44) ng/mL和(0.82±0.16) ng/mL，四组间BNP和PCT比较差异均有统计学意义(P<0.01)；心力衰竭合并重症肺炎及非重症肺炎患者CRP水平分别为(118.37±31.25) mg/mL和(86.37±27.41) mg/mL，明显高于单纯心力衰竭的(5.82±1.44) mg/mL及对照组的(5.15±1.27) mg/mL，差异均有显著统计学意义(P<0.01)，而心力衰竭合并重症细菌性肺炎患者CRP水平明显高于非重症肺炎患者，差异有统计学意义(P<0.05)。结论 BNP、CRP和PCT不仅是心力衰竭合并重症细菌性肺炎的敏感诊断指标，并且可以作为评估疾病严重程度的有效因子。
      【关键词】 心力衰竭；重症细菌性肺炎；C反应蛋白；B型脑钠肽；降钙素原
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2018）24—3417—03

Changes and clinical significance of B-type brain natriuretic peptide, C-reactive protein and procalcitonin inpatients with heart failure complicated with severe bacterial pneumonia.
MENG Xian-mei 1, LIN Hong-fei 2, LI Pu 3.1. Department of Critical Care Medicine, Xi'an Gaoxin Hospital, Xi'an 710075, Shaanxi, CHINA; 2. Department ofRespiratory, the Third People's Hospital of Baoji City, Baoji 721006, Shaanxi, CHINA; 3. Department of Intensive Care Unit,the Second Affiliated Hospital of the Fourth Military Medical University, Xi'an 710038, Shaanxi, CHINA
【Abstract】 Objective To observe the changes of B-type brain natriuretic peptide (BNP), C-reactive protein(CRP) and procalcitonin (PCT) levels in patients with heart failure complicated with severe bacterial pneumonia, and toexplore their clinical significance. Methods Among them, 212 patients with heart failure complicated with bacterialpneumonia, 80 patients with non-infectious heart failure and 60 healthy people, who were diagnosed and treated in theXi'an Gaoxin Hospital from February 2011 to February 2018, were selected as subjects. The levels of BNP, CRP and PCTin the blood of each group were detected and compared. Results Among the 212 patients with heart failure complicatedwith bacterial pneumonia, 67 had severe pneumonia, accounting for 31.60%, of which the proportion of patients over 70years old (40.28%) was significantly higher than that of patients under 70 years old (27.14%), and the incidence of sum-mer (14.81%) was significantly lower than that of spring (32.26%), autumn (31.03%) and winter (38.46%), all with statis-tically significant differences (P<0.05). The BNPs of heart failure complicated with severe pneumonia, combined withnon-severe pneumonia, simple heart failure and control group were (582.64±91.07) ng/L, (417.06±81.37) ng/L, (252.64±72.82) ng/L and (69.28±6.15) ng/L, respectively; PCT were (5.11±1.08) ng/mL, (3.82±0.68) ng/mL, (2.12±0.44) ng/mLand (0.82±0.16) ng/mL, respectively; all differences of BNP and PCT between the four groups were statistically signifi-cant (P<0.01). The CRP levels in patients with heart failure complicated with severe pneumonia and those combined withnon-severe pneumonia were (118.37 ± 31.25) mg/mL and (86.37 ± 27.41) mg/mL, respectively, which were significantlyhigher than (5.82±1.44) mg/mL in patients with simple heart failure and (5.15±1.27) mg/mL in the control group; the dif-ferences were statistically significant (P<0.01). The level of CRP was significantly higher in patients with heart failurecomplicated with severe bacterial pneumonia than those combined with non-severe pneumonia, and the difference was sta-tistically significant (P<0.05). Conclusion BNP, CRP and PCT are not only sensitive diagnostic indicators for heart fail-ure complicated with severe bacterial pneumonia, but also an effective factor for evaluating the severity of the disease.
      【Key words】 Heart failure; Severe bacterial pneumonia; C-reactive protein; Type B brain natriuretic peptide; Pro-calcitonin·论 著·d