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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2019, Vol. 12 ›› Issue (03) : 169 -173. doi: 10.3877/cma.j.issn.1674-6880.2019.03.005

所属专题： 文献；

荟萃分析

自主呼吸试验期间B型钠尿肽变化百分比对有创机械通气患者脱机结局预测价值的Meta分析
曹薇1, 吴秀1, 张斌1, 王胜昱1,†()   
  1. 1. 710077　西安，西安医学院第一附属医院呼吸与危重症医学科
  • 收稿日期:2018-12-19 出版日期:2019-06-01
  • 通信作者: 王胜昱
  • 基金资助:
    陕西省呼吸病预防与诊治工程研究中心开放基金项目(2016HXKF09); 陕西省重点研发计划项目(2017SF-256)

Predictive value of percent change in brain natriuretic peptide for endotracheal tube extubation in invasive mechanically ventilated patients during spontaneous breathing trial: a meta-analysis

Wei Cao1, Xiu Wu1, Bin Zhang1, Shengyu Wang1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
  • Received:2018-12-19 Published:2019-06-01
  • Corresponding author: Shengyu Wang
  • About author:
    Corresponding author: Wang Shengyu, Email:
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引用本文：

曹薇, 吴秀, 张斌, 王胜昱. 自主呼吸试验期间B型钠尿肽变化百分比对有创机械通气患者脱机结局预测价值的Meta分析[J]. 中华危重症医学杂志(电子版), 2019, 12(03): 169-173.

Wei Cao, Xiu Wu, Bin Zhang, Shengyu Wang. Predictive value of percent change in brain natriuretic peptide for endotracheal tube extubation in invasive mechanically ventilated patients during spontaneous breathing trial: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(03): 169-173.

目的

探讨自主呼吸试验（SBT）期间B型钠尿肽水平变化百分比（BNP%）对有创机械通气患者的预测价值。

方法

检索PubMed、Embase、Medline、Ovid、Cochrane Central Register of Controlled Trails和the Information Sciences Institute Web of Science从建库开始到2018年3月31日发表的有关BNP%预测有创机械通气患者脱机结局文献。采用Quasas-2工具对文献进行质量评价，采用MetaDiSc软件进行异质性分析，并计算合并诊断比值比（DOR）、合并敏感度、合并特异度、合并阳性似然比（PLR）及合并阴性似然比（NLR）。同时绘制合并受试者工作特征（SROC）曲线，获得曲线下面积。

结果

纳入5篇文献，共213名患者。Meta分析结果显示，合并DOR为22.33 [95%置信区间（CI）（9.25，53.91）]，合并敏感度为85%[95%CI（0.78，0.91）]，合并特异度为80%[95%CI（0.68，0.90）]，合并PLR为3.72 [95%CI（2.11，6.55）]，合并NLR为0.18 [95%CI（0.12,0.28）]。且合并DOR、合并敏感度、合并特异度、合并PLR、合并NLR分析均提示无明显异质性（P均> 0.1，I2均< 50%），SROC曲线下面积为0.913。

结论

BNP%对SBT期间有创机械通气患者脱机结局预测价值的诊断准确度高。

关键词: B型钠尿肽, 通气机，机械, 自主呼吸试验
Objective

To assess the predictive value of percent change in brain natriuretic peptide (BNP%) for endotracheal tube extubation in invasive mechanically ventilated patients during spontaneous breathing trial (SBT).

Methods

Searches were conducted in the PubMed, Embase, Medline, Ovid, Cochrane Central Register of Controlled Trails and Information Sciences Institute Web of Science for studies on the predictive value of BNP% for endotracheal tube extubation in invasive mechanically ventilated patients published up to March 31, 2018. The Quality Assessment of Diagnostic Accuracy Studies (Quasas-2) was used for quality assessment. The MetaDiSc was used for heterogeneity analysis, and the pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), and the area under the summary receiver operating characteristic (SROC) curve were calculated.

Results

A total of 213 patients were recruited from 5 trials. Meta-analysis showed that the pooled DOR was 22.33 [95% confidence interval (CI) (9.25, 53.91)], the pooled sensitivity was 85% [95%CI (0.78, 0.91)], the pooled specificity was 80% [95%CI (0.68, 0.90)], the pooled PLR was 3.72 [95%CI (2.11, 6.55)], and the pooled NLR was 0.18 [95%CI (0.12, 0.28)]. The pooled DOR, sensitivity, specificity, PLR, and NLR showed no significant heterogeneity (all P > 0.1, all I2 < 50%), and the area under the SROC curve was 0.913.

Conclusion

BNP% can elevate the predictive value for endotracheal tube extubation in invasive mechanically ventilated patients during SBT.

Key words: Brain natriuretic peptide, Ventilators, mechanical, Spontaneous breathing trial
表1 纳入文献的基本特征
第一作者 国家 例数 性别比（例，男/女） 阈值（%） AUC（95%CI） 真阳性值 假阳性值 真阴性值 假阴性值 敏感度（%） 特异度（%）
Farghaly[2] 埃及 30 13/17 14.9 0.80（0.66，0.92） 13 5 9 3 81.25 65.00
Chien[12] 中国 52 37/15 20.0 0.93（0.85，1.00） 37 1 10 4 91.00 88.00
Maraghi[24] 埃及 40 26/14 20.0 0.96（-） 27 1 7 5 85.71 90.91
Dres[23] 法国 21 12/9 12.0 0.76（0.60，0.93） 8 2 9 2 76.00 78.00
Cheng[22] 中国 56 29/27 13.4 0.88（0.79，0.97） 37 2 10 7 84.80 82.60
图1 纳入文献的质量评价
图2 BNP%对SBT期间有创机械通气患者脱机结局预测价值诊断的DOR
图3 BNP%对SBT期间有创机械通气患者脱机结局预测价值诊断的敏感度
图4 BNP%对SBT期间有创机械通气患者脱机结局预测价值诊断的特异度
图5 BNP%对SBT期间有创机械通气患者脱机结局预测价值诊断的PLR
图6 BNP%对SBT期间有创机械通气患者脱机结局预测价值诊断的NLR
1
Mekontso-Dessap A, de Prost N, Girou E, et al. B-type natriuretic peptide and weaning from mechanical ventilation[J]. Intensive Care Med, 2006, 32 (10): 1529-1536.
2
Farghaly S, Galal M, Hasan AA, et al. Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness[J]. Aust Crit Care, 2015, 28 (3): 116-121.
3
MacIntyre N. Discontinuing mechanical ventilatory support[J]. Chest, 2007, 132 (3): 1049-1056.
4
Cook DJ, Walter SD, Cook RJ, et al. Incidence of and risk factors for ventilator - associated pneumonia in critically ill patients[J]. Ann Intern Med, 1998, 129 (6): 433-440.
5
Epstein SK. Etiology of extubation failure and the pre-dictive value of the rapid shallow breathing index[J]. Am J Respir Crit Care Med, 1995, 152 (2): 545-549.
6
Esteban A, Alía I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group[J]. Am J Respir Crit Care Med, 1997, 156 (2 Pt 1): 459-465.
7
Crisp AH. The differential diagnosis of anorexia nervosa[J]. Proc R Soc Med, 1977, 70 (10): 686-690.
8
MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine[J]. Chest, 2001, 120 (6 Suppl): 375S-395S.
9
Lemaire F, Teboul JL, Cinotti L, et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation[J]. Anesthesiology, 1988, 69 (2): 171-179.
10
Jubran A, Mathru M, Dries D, et al. Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof[J]. Am J Respir Crit Care Med, 1998, 158 (6): 1763-1769.
11
Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey[J]. Clin J Am Soc Nephrol, 2006, 1 (1): 43-51.
12
Chien JY, Lin MS, Huang YC, et al. Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial[J]. Crit Care Med, 2008, 36 (5): 1421-1426.
13
Lamia B, Maizel J, Ochagavia A, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation[J]. Crit Care Med, 2009, 37 (5): 1696-1701.
14
de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease[J]. Lancet, 2003, 362 (9380): 316-322.
15
Wiese S, Breyer T, Dragu A, et al. Gene expression of brain natriuretic peptide in isolated atrial and ventricular human myocardium: influence of angiotensin Ⅱ and diastolic fiber length[J]. Circulation, 2000, 102 (25): 3074-3079.
16
Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure[J]. N Engl J Med, 2002, 347 (3): 161-167.
17
Jefic D, Lee JW, Jefic D, et al. Utility of B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide in evaluation of respiratory failure in critically ill patients[J]. Chest, 2005, 128 (1): 288-295.
18
Rudiger A, Gasser S, Fischler M, et al. Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure[J]. Crit Care Med, 2006, 34 (8): 2140-2144.
19
Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1 256 patients: the International Collaborative of NT-proBNP Study[J]. Eur Heart J, 2006, 27 (3): 330-337.
20
郭明，杨杰，张亚梅, 等. 依据B型钠尿肽水平调整急性冠脉综合征患者β受体阻滞剂使用的临床研究[J/CD]. 中华危重症医学杂志（电子版）, 2015, 8(5): 296-299.
21
周玥，傅永平. 血浆B型利钠肽在不同左心功能肺心病患者中的临床价值探讨[J/CD]. 中华危重症医学杂志（电子版）, 2016, 9(3): 184-186.
22
Cheng L, Jiang L, Wang M, et al. The value of changes in plasma B-type natriuretic peptide before and after spontaneous breathing trial in predicting weaning outcome in mechanically ventilated patients[J]. Zhonghua Nei Ke Za Zhi, 2015, 54 (6): 486-490.
23
Dres M, Teboul JL, Anguel N, et al. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema[J]. Crit Care Med, 2014, 42 (8): 1882-1889.
24
Maraghi SE, Hosny M, Samir M, et al. Usage of B-type natriuretic peptide for prediction of weaning outcome by spontaneous breathing trial[J]. Egypt J Chest Dis Tuberc, 2014, 63 (3): 671-678.
25
Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests[J]. BMJ, 2001, 323 (7305): 157-162.
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