血清N末端脑钠肽前体水平与脓毒症预后的关系  

The relationship between the level of N-terminal pro-B-type natriuretic peptide and prognosis in patients with sepsis

作　　者：刘健[1] 王洪霞[1] 门昆[2] 

机构地区：[1]天津医科大学第二医院急诊科,300211 [2]天津医科大学第二医院化验室,300211

出　　处：《中国危重病急救医学》2012年第11期662-664,共3页Chinese Critical Care Medicine

基　　金：天津市医药卫生科技基金项目（09KZ93）

摘　　要：目的通过检测脓毒症患者血清N末端脑钠肽前体（NT-proBNP）水平，探讨其与脓毒症预后的关系。方法采用前瞻牲病例对照研究，选择2010年5月至2011年10月天津医科大学第二医院重症监护病房（ICU）收治的60例脓毒症患者，其中脓毒症39例，严重脓毒症21例。于入院1d、3d检测血清NT-proBNP水平，计算急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，并绘制受试者工作特征曲线（ROC曲线）。按照28d转归分为生存组（42例）和死亡组（18例），以同期30例健康体检者作为对照组。结果所有脓毒症患者1d、3dNT-proBNP水平（ng／L）明显高于健康对照者（65．77±34．78、74．23±42．12比48．36±35．53，P〈0．05和P〈0．01）。严重脓毒症组1dNT-proBNP水平显著高于脓毒症组（71．69±32．86比50．11±36．98，P〈0．05），3d两组无差异；死亡组随病程延长NT-proBNP水平逐渐升高，且3d时显著高于生存组（99．20±44．34比66．79±39．28，P〈0．05），1d两组无差异。严重脓毒组1d、3dAPACHEⅡ评分（分）明显高于脓毒症组（1d：23．92±7．57比14．87±6．50。3d：19．28±8．80比10．43±7．27，均P〈0．01）；死亡组1d、3dAPACHEⅡ评分均明显高于生存组（1d：26．71±6．72比18．83±7．84，3d：31．11±5．06比13．80±7．27，均P〈0．01）。以NT-DroBNP≥63．5ng／L、APACHEⅡ评分≥20分为截断点评价脓毒症患者的预后，其敏感性分别为65．4％、88．5％，特异性分别为62．5％、69．4％。结论血清NT-proBNP水平升高提示脓毒症患者预后差。Objective To detect the relationship between the level of N-terminal pro-B-type natriuretic peptide （NT-proBNP） and prognosis in patients with sepsis. Methods A prospective controlled study was conducted. Sixty cases, including 39 sepsis and 21 severe sepsis, were enrolled from May 2010 to October 2011 in intensive care unit （ ICU ） of Second Hospital of Tianjin.Medical University. The serum level of NT-proBNP was determined and acute physiology and chronic health evaluationⅡ（APACHEⅡ） score was calculated on the 1st and 3rd day. The receiver operator characteristic curve （ROC curve） was draw. According to the 28-day prognosis, all patients were divided into the survival group （n =42 ） or the death group （n = 18 ）. At the same time 30 healthy people were enrolled as control group. Results The level of NT-proBNP （ng/L） in the sepsis patients on the 1 st and 3rd day were significantly higher than those of healthy controls （65.77 ± 34.78, 74.23 ± 42.12 vs. 48.36 ± 35.53, P〈0.05 and P〈0.01 ）. The level on 1st day of the severe sepsis group was higher than sepsis group （71.69 ± 32.86 vs. 50.11 ± 36. 98, P〈0.05 ）, but there was no statistically significance on the 3rd day. The level of NT-proBNP in death group was increased gradually and significantly higher than that of survival group on the 3rd days （99.20 ± 44.34 vs. 66.79 ± 39.28, P〈0.05）, but no difference was found on the 1st day. The APACHE Ⅱ score of severe sepsis group were much higher than those of sepsis group on the 1st and 3rd day （ 1st day：23.92 ± 7.57 vs. 14.87 ±6.50, 3rd day： 19.28 ± 8.80 vs. 10.43 ± 7.27, both P〈 0.01 ）. The APACHE Ⅱ score of death group were also much higher than those of survival group on the 1st and 3rd day （ 1st day：26.71 ± 6.72 vs. 18.83 ± 7.84, 3rd day：31.11 ± 5.06 vs. 13.80 ± 7.27, both P〈0.01 ）. The cut point for the evaluation of sepsis prognosis were NT-proBNP ≥ 63.5 ng/L and APACHE Ⅱ score ≥ 20, which sensitivity were 65.4% and 88

关 键 词：脓毒症 N末端脑钠肽前体 急性生理学与慢性健康状况评分系统Ⅱ评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]