血浆脑钠肽水平对脓毒性休克患者预后的评价  

Prognostic value of plasma B-type natriuretic peptide in patients with septic shock

作　　者：邢柏[1] 王小智[1] 曾琦[1] 谭世峰 黄山[1] 

机构地区：[1]海南省农垦总医院,海南海口570203

出　　处：《中国现代医学杂志》2013年第32期75-79,共5页China Journal of Modern Medicine

基　　金：海南省自然科学基金(No:811166)

摘　　要：目的评价血浆B型脑钠）Ik（BNP）水平对脓毒性休克患者预后的预测价值。方法回顾性分析2008年1月-2012年12月在该院ICU住院时间大于3d的脓毒性休克患者。依预后情况分为存活组和死亡组，比较两组患者相关指标；评价各指标对脓毒性休克患者预后的预测价值。结果共入选128例患者，存活组82例，死亡组46例。与死亡组比较，存活组APACHEII评分、SOFA相对较低（P〈0．01）。死亡组第3天BNP水平（BNP3）明显高于存活组（P〈0．01）；入ICU第1天、前3天的液体平衡，存活组与死亡组差异有统计学意义（P=0．000，0．000），液体负平衡者病死率低。BNP3预测脓毒性休克患者死亡的ROC曲线下面积为（0．820±0．040）（95％C10．742～0．899），BNP3〉255pg/mL时，预后评价的敏感性为76．1％，特异性为78．0％。结论血浆BNP水平对脓毒性休克患者预后评价具有重要意义。[Objective] To investigate the prognostic value of plasma B-type natriuretic peptide （BNP） in the patients with septic shock. [Methods] The data of the patients with septic shock, with an expected In tensive care unit （ICU） stay of more than 3 days, from January 2008 to December 2012, were retrospective reviewed. All patients were divided into the survival group and non-survival group according to whether they survived within 28 days. Related indicators were compared between two groups. Then evaluate the value of each indicator in predicting the prognostic in the patients with septic shock. [Results] A total of 128 pa tients were eligible for inclusion in the study, and there were 82 cases in the survival group and 46 cases in the nonsurvival group. Compared with the non-survival group, APACHE Ⅱ score and SOFA score of the survival group was lower （P〈0.01）. The BNP3 （the BNP of the third day） in the non-survival group were sig nificantly higher than those of the survival group （P 〈0.01）. There was a significant difference between the survivors and the non-survivors in the fluid balance at the first day and the following three days （P=0.000, 0.000）, negative fluid balance was associated with a lower mortality. The area under cure （AUC） of the re ceiver operating characteristic （ROC） cure of BNP3 to predict the prognostic of the patients with septic shock was （0.820± 0.040）, （95%CI 0.742-0.899）. If BNP3 〉255 pg/mL, the sensitivity and the specificity of accurate judgment were 76.1% and 78%. [Conclusion] The plasma BNP concentration is an important marker for pre dicting the prognosis of patients with septic shock.

关 键 词：B型脑钠肽 脓毒性休克 预测价值 

分 类 号：R446.1[医药卫生—诊断学] R541.64[医药卫生—临床医学]