脑利钠肽、肌钙蛋白T和I监测对重症脓毒症和脓毒症休克预后的意义  

Prognostic value of monitoring B-type natriuretic peptide, cardiac troponin T and troponin I insevere sepsis and septic shock

作　　者：李振华[1] 董磊[2] 王国兴[1] 谢苗荣[1] 

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050 [2]首都医科大学附属北京友谊医院重症医学科,北京100050

出　　处：《中华急诊医学杂志》2012年第9期1016-1021,共6页Chinese Journal of Emergency Medicine

摘　　要：目的比较重症脓毒症和脓毒症休克时脑利钠肽（BNP）、肌钙蛋白T（TnT）及肌钙蛋白I（TnI）水平的差异，探索重症脓毒症及脓毒症休克时心脏损害的程度及检测BNP、TnT及TnI的意义。方法回顾性分析2005年至2010年在北京首都医科大学附属北京友谊医院住院诊断为重症脓毒症和脓毒症休克的患者共98例，住院期间行超声心动图检查，住院第1、3、7天检测BNP，TnT及TnI。其中重症脓毒症患者57例，脓毒症休克患者41例。重症脓毒症组（S）分为心功能正常组（Sn）、心功能异常组（sa）、死亡组（Sd）和存活组（Ss）四个亚组，脓毒症休克组（SS）分为心功能正常组（SSn）、心功能异常组（SSa）、死亡组（SSd）及存活组（SSs）四个亚组。X2检验判断各组病死率的是否存在统计学差异，SNK—q比较各组间血浆BNP、TnT、TnI水平是否具有统计学差异，以直线相关判断上述指标与EF值的相关性，受试者工作曲线（ROC）评估上述指标与预后的关系。结果（1）S组和SS组的BNP和TnI水平差异无统计学意义，但SS组的TnT水平明显高于S组（P=0．001）；（2）Sa组BNP、TnT及TnI显著高于Sn组，Sd组BNP明显高于Ss组（P=0．001）；（3）SSa组BNP、TnT及TnI明显高于SSn组，SSd组BNP明显高于SSs组（第1天P=0．001，第3天P=0．001，第7天P=0．016）；（4）SSn组的TnT、TnI显著高于Sn组，且SSn组第1、3、7天的BNP均明显高于Sn组（第1天P=0．006，第3天P=0．006，第1天P=0．001）；（5）Sd及SSd组的BNP均明显高于Ss组和SSs组；（6）S组与SS组中心功能异常组的病死率更高，差异具有统计学意义（Sa与Sn组比较，P〈0．05，SSa与SSn组比较，P〈0．05）；（7）Sd和SSd患者入院时的EF值和BNP水平呈负相关（r=0．603，P〈0．01），入院72h内BNP水平〉0．39ng／ml可作为预测死亡的临界点，其敏感度92．9％，特异性80．8％。结论血浆BNP�Objective To investigate the degree of cardiac function impairment, and clinical implications of BNP, TnT and TnI in patients with severe sepsis and septic shock retrospectively by comparing the differences in levels of BNP, TnT and TnI among those patients. Methods From December 2005 through December 2010, 98 patients admitted with severe sepsis （ n = 57） or septic shock （ n = 41 ） were enrolled to be studied. The inclusion criteria were （ 1 ） echocardiography was pefforuled ; （2） levels of serum BNP, TnT and Tnl were determined on the 1st day, 3rd day and 7th days after admission. These 98 patients were divided into 2 major groups： severe sepsis group （S） and septic shock group （SS） ; and each major group was further divided into 4 subgroups, including severe sepsis normal cardiac function （Sn） ; severe sepsis abnormal cardiac function （Sa）; severe sepsis death （Sd）, severe sepsis survival （Ss）;septic shock normal cardiac function （ SSn）, septic shock abnormal cardiac function （ SSa）, septic shock death （SSd） and septic shock survival （SSs）. Then comparisons of the plasma levels of BNP, TnT and TnI were carried out among groups respectively. The morality difference between groups S vs SS, and Savs Sn, and SSa vs SSn were compared by using the Chi-square Test. The differences in BNP, TnT and TnI between groups were compared by SNK-q test. Correlation between ejection fraction （EF） value and those biomarkers was calculated by Pearson correlation coefficient. The relationship between those biomarkers and outcomes was determined by using receiver operating characteristic curve （ROC）. Results （ 1 ） There were no significant differences in levels of BNP and TnI between group S and SS, but TnT level in patients of SS group was significantly higher than that in S group （ P = 0. 001 ）. （2） TnT, BNP, TnI levels in Sa group were significantly higher than those in group Sn; and BNP level in group SSd was significantly higher than that in SSs grou

关 键 词：重症脓毒症 脓毒症休克 脑利钠肽 肌钙蛋白T 肌钙蛋白I 心肌损伤 射血分数 预后 

分 类 号：R459.7[医药卫生—急诊医学]