cTnI 和 NT －proBNP 联合 APACHEⅡ评分在评估老年感染性休克患者预后中的价值  

Predictive value of plasma cardiac troponin I, N-terminal-pro-brain natriuretic peptide and APACHEⅡscore in elderly patients with septic shock

作　　者：李丽娟[1] 阮冬石 刘国梁[1] 李俊[1] 陶新曹[1] 林江涛[1] 

机构地区：[1]中日友好医院RICU,北京100029

出　　处：《中国急救医学》2015年第4期297-300,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的：探讨影响老年感染性休克患者预后的危险因素。方法回顾2012－01～2014－05重症监护病房（ ICU ）老年感染性休克患者61例，统计患者一般资料，入院24 h内行cTnI、CK－MB、血浆proBNP浓度等指标检测，按照28 d是否存活，分为存活组和死亡组，比较存活组与死亡组血乳酸（ Lac）、血肌酐（ CRE）、cTnI、CK－MB、NT－proBNP、APACHEⅡ评分，并绘制受试者工作特征曲线（ ROC曲线），分析各指标预测患者预后的意义。结果①死亡组患者的CK－MB、Lac、CRE、NT－proBNP、APACHEⅡ评分均明显高于存活组（P＜0．01）。②各指标预测28 d预后的ROC曲线图显示， APACHEⅡAUC ＝0．924，截断值为22．5，在此截断值下的敏感度为90.0％，特异度为81．0％；NT－proBNPAUC ＝0．869，预测老年感染性休克患者预后的截断值为1256 ng／L，在此截断值下的敏感度为92．5％，特异度为81．0％；其余各指标曲线下面积均低于NT－proBNP，CREAUC ＝0．835，LacAUC ＝0．731，CK－MBAUC ＝0．711。结论 cTnI、NT－proBNP水平和APACHEⅡ评分是预测老年感染性休克患者预后的独立因素。Objective To investigate the predictive value of biochemical markers with myocardial injury and plasma N-terminal-pro-brain natriuretic peptide （ NT-proBNP） in patients with elderly sepsis patients.Methods A total of 61 intensive care unit （ ICU） elderly patients with sepsis shock were enrolled from January 2012 to May 2013, general information were collected.Blood gas analysis, blood biochemistry, cardiac troponin I （ cTnI ） , CK -MB, plasma NT -proBNP concentration were collected within 24 hours of admission.The enrolled patients were divided into the survival group and death group according to 28 -day mortality.The blood lactate （ Lac ） , creatinine （ CRE） , cTnI, CK -MB and NT -proBNP levels in two groups were compared, and the predictive value of the indicators were analyzed with receiver operating characteristic （ ROC） curve.Results①CK-MB, Lac, CRE, NT-proBNP, APACHEⅡlevels in the death group were significantly higher than those in the survival group （P〈0.01）.②The ROC curve that prognostic indicators forecast 28 days shows, APACHEⅡAUC =0.924, the cut-off point value （cut-off） predict prognosis is 22.5 with a sensitivity of 90.0%and specificity of 81.0%.NT-proBNPAUC =0.869, the cut-off point value is 1256 ng/L with a sensitivity of 92.5%, specificity of 81.0%.The remaining area under the curve of each index were lower than NT-proBNP, CREAUC =0.835, LacAUC =0.731, CK-MBAUC =0.711. Conclusion cTnI, NT-proBNP and APACHEⅡare independent prognostic factors to predict elderly patients with septic shock.

关 键 词：N端脑钠素前体(NT-proBNP) 心肌肌钙蛋白I(cTnI) 感染性休克 预后 

分 类 号：R543.3[医药卫生—心血管疾病]