作者：潘鑫，赵炳联，陈倩

单位：

102401北京市房山区良乡医院急诊科

Units：

Department of Emergency, Liangxiang Hospital, Fangshan District, Beijing 102401, China

关键词：

呼吸窘迫综合征；超声检查；N末端脑钠肽前体；肺水肿

Keywords：

Respiratory distress syndrome; Ultrasonography; N-terminal pro-brain natriuretic peptide; Pulmonary edema

CLC：

R 563.8

DOI：

10.12114/j.issn.1008-5971.2024.00.009

Funds：

北京市房山区良乡医院院级科研课题（2020-07）

摘要：

目的　分析肺部超声检查参数联合血清N末端脑钠肽前体（NT-proBNP）对急性呼吸窘迫综合征 （ARDS）患者肺水肿程度的预测价值。方法　选取2021年1月—2022年3月北京市房山区良乡医院收治的ARDS患者 180例为研究对象。收集患者一般资料、脉搏指示连续心排血量（PiCCO）技术检测结果〔肺血管通透性指数（PVPI） 和血管外肺水指数（EVLWI）〕、肺部超声检查结果（ B线数目）、血清 NT-proBNP 。根据EVLWI 将患者分为重度肺 水肿组（EVLWI＞10 ml/kg， n=95）和轻度肺水肿组（EVLWI ≤10 ml/kg， n=85）。采用多因素 Logistic 回归分析探讨 ARDS患者肺水肿程度的影响因素，采用ROC曲线分析B线数目、血清NT-proBNP及其联合对ARDS患者肺水肿程度的 预测价值。结果　重度肺水肿组PVPI、血清NT-proBNP高于轻度肺水肿组，B线数目多于轻度肺水肿组（P＜0.05）。 多因素Logistic回归分析结果显示，B线数目、血清NT-proBNP是ARDS患者肺水肿程度的独立影响因素（P＜0.05）。 ROC曲线分析结果显示，B线数目、血清NT-proBNP预测ARDS患者重度肺水肿的曲线下面积分别为0.857〔95%CI （0.809～0.903）〕、0.838〔95%CI（0.786～0.893）〕，最佳截断值分别为40.5条、10.2 μg/L，灵敏度分别为 79.53%、69.14%，特异度分别为80.48%、77.75%；二者联合预测ARDS患者重度肺水肿的曲线下面积为0.977〔95%CI （0.959～0.994）〕，灵敏度和特异度分别为85.48%、81.29%。结论　B线数目增多、血清NT-proBNP升高是ARDS患 者重度肺水肿的独立危险因素；B线数目、血清NT-proBNP均对ARDS患者肺水肿程度有一定预测价值，且二者联合的 预测价值较高。

Abstract：

Objective To analyze the predictive value of pulmonary ultrasound examination parameters combined with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) for the degree of pulmonary edema in patients with acute respiratory distress syndrome (ARDS) . Methods A total of 180 ARDS patients admitted to Liangxiang Hospital, Fangshan District from January 2021 to March 2022 were selected as the study objects. General data, pulse indicator continous cardiac output (PiCCO) technology test results [pulmonary vascular permeability index (PVPI) and extravasrular lung water index (EVLWI) ] , lung ultrasound examination results (number of B-lines) , and serum NT-proBNP were collected. According to EVLWI, the patients were divided into severe pulmonary edema group (EVLWI > 10 ml/kg, n=95) and mild pulmonary edema group (EVLWI ≤ 10 ml/kg, n=85) . Multivariate Logistic regression analysis was used to explore the influencing factors of the degree of pulmonary edema in ARDS patients, and ROC curve was used to analyze the predictive value of B-line number, serum NT-proBNP and their combination for the degree of pulmonary edema in ARDS patients. Results PVPI and serum NT-proBNP in severe pulmonary edema group were higher than those in mild pulmonary edema group, and the number of B-line was more than that in mild pulmonary edema group (P < 0.05) . Multivariate Logistic regression analysis showed that the number of B-line and serum NT-proBNP were independent influencing factors of the degree of pulmonary edema in ARDS patients (P < 0.05) . ROC curve analysis results showed that the area under the curve of B-line number and serum NT-proBNP in predicting severe pulmonary edema in ARDS patients was 0.857 [95%CI (0.809-0.903) ] and 0.838 [95%CI (0.786-0.893) ] , respectively. The best cutoff values were 40.5 and 10.2 μg/L, the sensitivity was 79.53% and 69.14%, and the specificity was 80.48% and 77.75%, respectively. The area under the curve of their combination in predicting severe pulmonary edema in ARDS patients was 0.977 [95%CI (0.959-0.994) ] , and the sensitivity and specificity were 85.48% and 81.29%, respectively. Conclusion Increased B-line number and increased serum NT-proBNP are independent risk factors for severe pulmonary edema in ARDS patients. The number of B-lines and serum NT-proBNP have certain predictive value for the degree of pulmonary edema in ARDS patients, and the predictive value of their combination is relatively high.

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