重症肺炎致急性呼吸窘迫综合征患者血NT-proBNP、cTnI水平的临床观察及其与炎性反应的相关性研究

目的：本研究通过观察重症肺炎致急性呼吸窘迫综合征（ARDS）患者血N末端B型钠尿肽前体（NT‐proBNP）、肌钙蛋白I（cTnI）水平及其与C‐反应蛋白（CRP）之间的关系，从而进一步深入探讨ARDS ，尤其是ARDS后继发心肌损伤的病理生理过程及临床意义。方法将确诊为重症肺炎致ARDS的患者33例分为轻度、中度、重度3组，收集患者入院时血气分析、CRP、NT‐proBNP、cTnI等相关指标数据，并进行统计学分析。结果重度组NT‐proBNP水平明显高于轻、中度组（P＜0．01），中度组NT‐proBNP水平也较轻度组升高（P＜0．05）；重度组cTnI水平与轻、中度组比较明显增高（P＜0．01），而轻、中度组间比较差异无统计学意义（P＞0．05）；3组间CRP水平也有随着病情加重而逐渐升高，重度组CRP水平显著高于轻度组（P＜0．05）；ARDS患者血NT‐proBNP水平与CRP水平呈显著正相关（P＜0．05），且与cTnI水平呈正相关关系（P＜0．05）。结论 ARDS病程中过度活化的炎性反应很可能直接参与并介导心肌损伤的病理生理过程；联合NT‐proBNP、cTnI检测对ARDS病程早期评价，及早期实施器官功能保护有着重要临床意义。

Correlative study between NT-proBNP,cTnI levels and inflammation reaction in patients with acute respiratory distress syndrome caused by severe pneumonia

Objective To investigate the association betweent clinical markers of N‐terminal probrain natriuretie peptide (NT‐proBNP) ,cardiac troponin I (cTnI) and C‐reaction protein (CRP) in the patients with acute respiratory distress syndrome (ARDS) caused by severe pneumonia and to reveal the pathophysiologic process of myocardial injury after ARDS .Methods Totally 33 patients diagnosed as ARDS caused by severe pneumonia were divided into 3 groups:mild group ,moderate group and severe group according to the New Berlin definition of ARDS .Arterial blood gas analysis ,NT‐proBNP ,cTnI and CRP were observed be‐fore the treatment .Statistics were used for the analyses .Results The NT‐proBNP level in the severe group was significantly higher than that in the mild and moderate groups (P<0 .01);the NT‐proBNP level in the moderate group was also higher than that in the mild group (P< 0 .05) .Besides ,the cTnI level in the severe group was significantly higher than that in the mild and moderate groups (P<0 .01);however ,the cTnI level had no statistical difference between mild and moderate groups (P> 0 .05) .The CRP level in the severe group was significantly higher than that in the mild (P<0 .05) .Moreover ,the NT‐proBNP level of 33 patients was positively associated with the both CRP and cTnI level (P<0 .05) .Conclusion The seriously inflammatory response mediates myocardial injury probably because of ARDS .Combined NT‐proBNP and cTnI testing is important for evaluating the condition of ARDS at the early stage .