感染性休克患者血浆N末端B型钠尿肽前体与血管外肺水指数的相关性研究  

The association between plasma N-terminal pro-B-type natriuretic peptide and extravascular lung water index in patients with septic shock

作　　者：王锁柱[1] 李丽娟[1] 赵磊[1] 盛博[1] 古旭云[1] 陈炜[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院重症医学科,北京100038

出　　处：《中国中西医结合急救杂志》2014年第1期58-62,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：首都医学发展科研基金（2009-1034）

摘　　要：目的：探讨感染性休克患者血浆N末端B型钠尿肽前体（NT-proBNP）水平动态变化与血管外肺水指数（EVLWI）的相关性。方法选择首都医科大学附属北京世纪坛医院重症医学科62例感染性休克患者，按28 d生存情况分为存活组（39例）和死亡组（23例），于入重症监护病房（ICU）后取静脉血，分析血浆NT-proBNP水平和血流动力学指标变化及其对临床结局的预测价值。结果存活组患者入ICU 24 h内急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分（分：23.2＆#177;2.5比28.1＆#177;2.6）、序贯器官衰竭评分〔SOFA评分（分）：7.74＆#177;2.80比12.43＆#177;3.00〕及入院后72 h时血流动力学指标EVLWI〔mL/kg：7.0（6.0，8.0）比9.0（7.0，12.0）〕、血乳酸（mmol/L：3.60＆#177;2.30比10.40＆#177;2.70）和NT-proBNP〔ng/L：945.0（228.0，1246.0）比5471.0（3308.0，11174.0）〕水平均明显低于死亡组。心排血指数〔CI（L？min-1？m-2）：4.23＆#177;0.85比3.31＆#177;0.74〕、全心射血分数（GEF：0.205＆#177;0.054比0.149＆#177;0.054）均明显高于死亡组（P＜0.05或P＜0.01）。相关分析显示，NT-proBNP与EVLWI呈显著正相关（r＝0.277，P＝0.010），与CI、GEF呈显著负相关（r1＝-0.367，P1＝0.001；r2＝-0.259，P2＝0.017），而与GEDVI、SVRI无明显相关性。受试者工作特征曲线（ROC曲线）显示，血浆NT-proBNP预测感染性休克患者结局的ROC曲线下面积（AUC）为0.869＆#177;0.042，95%可信区间（95%CI）为0.786～0.952，以敏感度和特异度之和的最大值1.695确定NT-proBNP预测感染性休克患者死亡的截断值（cut-off）为2071 ng/L，在此截断值下的敏感度为81.4%，特异度为88.1%。EVLWI预测感染性休克患者结局的AUC最大值0.690，截断值为7.5 mL/kg，在此截断值下敏感度为69.8%，特异度为66.7%。CI预测感染性休克患者结局的AUC最大值0.785，截断值为3.48 L？min-1？m-2，在此截Objective To study the dynamic change in plasma N-terminal pro-B-type natriuretic peptide （NT-proBNP） levels and its correlation with extravascular lung water index （EVLWI） in patients with septic shock. Methods Sixty-two patients with septic shock admitted to Department of Critical Care Medicine of Beijing Shijitan Hospital were enrolled. The patients were divided into survival group（39 cases）and non-survivors group （23 cases）according to 28-day prognosis. Venous blood was collected after intensive care unit（ICU）admission. The changes in plasma NT-proBNP and hemodynamics indexes levels were analyzed to evaluate their predictive value for clinical outcomes. Results Acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）score（23.2＆#177;2.5 vs. 28.1＆#177;2.6）,sequential organ failure assessment（SOFA score：7.74＆#177;2.80 vs. 12.43＆#177;3.00）and hemodynamics indexes including EVLWI〔ml/kg：7.0（6.0,8.0）vs. 9.0（7.0,12.0）〕,blood lactate（mmol/L）：3.60＆#177;2.30 vs. 10.40＆#177;2.70）and NT-proBNP〔ng/L：945.0（228.0,1 246.0）vs. 5 471.0（3 308.0,11 174.0）〕in survivors were significantly lower than those in non-survivors,and cardiac index〔CI（L？min-1？m-2）：4.23＆#177;0.85 vs. 3.31＆#177;0.74〕, global ejection fraction（GEF：0.205＆#177;0.054 vs. 0.149＆#177;0.054）were significantly higher than those in non-survivors （P＆lt;0.05 or P＆lt;0.01）. Correlation analysis showed a positive correlation was found between NT-proBNP and EVLWI （r=0.277,P=0.010）,and negative correlations were found between NT-proBNP and CI（r=-0.367,P=0.001）, GEF（r=-0.259,P=0.017）. No correlation was found between NT-proBNP and GEDVI,SVRI. Receiver operating characteristic curve（ROC curve）analysis showed that the area under the ROC curve（AUC）for plasma NT-proBNP predicting the outcome of septic shock patients was 0.869＆#177;0.042,95% confidence interval（95%CI）was 0.786-0.952,with the maximum sum of sensitivity and specificity

关 键 词：感染性休克 N末端B型钠尿肽前体 血管外肺水指数 预后 

分 类 号：R541.63[医药卫生—心血管疾病]