老年脓毒症患者血浆氨基末端脑钠肽前体和肌钙蛋白I的临床价值  

Clinical value of N-terminal pro-brain natriuretic peptide and troponin I plasma levels in elderly patients with sepsis

作　　者：苏琴[1] 张宪[1] 姚亚宾 陈丽萍[1] 高诗博[1] 刘东昇[1] 刘阳[1] 姚咏明[1] 赵晓东[1] 

机构地区：[1]解放军总医院第一附属医院急救部,北京100048

出　　处：《中华急诊医学杂志》2013年第12期1379-1382,共4页Chinese Journal of Emergency Medicine

基　　金：国家重点基础研究发展规划项目（2005CB522602）

摘　　要：目的通过联合检测老年脓毒症患者血浆氨基末端脑钠肽前体（NT—proBNP）和肌钙蛋白I（cTnI）质量浓度，评价其对老年脓毒症患者的病情评估及预后判断的临床意义。方法用前瞻性研究方法，以2011年1月至2013年1月在解放军总医院第一附属医院急诊留观及急诊病房住院的老年脓毒症患者145例为研究对象，其中一般脓毒症组84例、严重脓毒症组45例、脓毒性休克组16例。来院后立即检测血浆NT-proBNP和cTnI质量浓度，行超声心动图检查测定LVEF值，进行APACHEⅡ评分。随访严重脓毒症及脓毒性休克组患者28d生存情况，对存活组（49例）及死亡组（12例）患者检测的各项指标进行比较；并比较NT—proBNP和cTnI与APACHEII评分的相关性。结果血浆NT-proBNP和cTnI在严重脓毒症组[（1375．48±537．15）pg／mL，（0．53±0．45）μg∥L]和脓毒性休克组[（2735．73±907．17）pg／mL，（1．94±1．14）μg／L]的质量浓度明显高于一般脓毒症组[（554．1±107．48）pg／mL，（0．08±0．07）μg∥L]，三组间比较差异均具有统计学意义（P〈0．01）；死亡组血浆NT—proBNP、cTnI质量浓度及APACHE11评分均明显高于存活组，LVEF值明显低于存活组，差异具有统计学意义；血浆NT-proBNP和cTnI质量浓度与APACHEⅡ评分呈正相关。结论血浆NT—proBNP和cTnI质量浓度可用于脓毒症患者的病情评估及预后判断。Objective To evaluate the clinical significance for assessment and prognosis of elder patients with sepsis by way of detecting plasma NT-proBNP and cTnl levels. Methods It was a prospective trial conducted. A total of 145 elderly patients with sepsis were admitted to the emergency observation center and the emergency ward from January 2011 through January 2013. Of them, there were 84 patients with mild sepsis, 45 patients with severe sepsis, and 16 patients with septic shock. Plasma levels of NT-proBNP and cTnI were assayed immediately after admission. The LVEF value was determined by echocardiography. The APACHE Ⅱ score was also determined. In the following 28 days, the survival of patients with severe sepsis and septic shock were investigated. Data of laboratory findings were analyzed for comparison between the survival group （ n = 49 ） and death group （ n = 12）. Results The plasma levels of NT-proBNP and cTnI in the severe sepsis group [ （1375.48 ±537.15） pg/mL, （0. 53 ±0. 45） μg/L] and in the septic shock group [ （2735.73 ±907. 17） pg/mL, （1.94 ± 1.14） μg/L] were signifieantly higher than those in themild sepsis group [ （554. 12 ± 107.48 ） pg/mL, （0. 08 ± 0. 07 ） μg/L]. The differences among three groups were statistically significant （ P 〈 0. 01 ）. The plasma levels of NT-proBNP and cTnI, and the APACHE score of the death group were significantly higher than those of the survival group. The LVEF values of the death group were significantly lower than that of the survival group （ P 〈 0. 05 ）. The plasma levels of NT-proBNP and cTnI and the APACHE I/ score were positively correlated. Conclusions The plasma levels of NT-proBNP and cTnI can be used for severity and prognosis assessment in patients with sepsis.

关 键 词：老年人 脓毒症 严重脓毒症 脓毒性休克 氨基末端脑钠肽前体 肌钙蛋白I 射血分数 预后 

分 类 号：R459.7[医药卫生—急诊医学]