N末端B型利钠肽原和降钙素原在老年脓毒血症患者预后评估中作用  

Role of N-terminal pro-brain natriuretic peptide and procalcitonin levels in the evaluation of the prognosis of elderly patients with sepsis

作　　者：朱红[1] 刘川[1] 马丽娜[1] 钱玉英[1] 李耘[1] 冯明[1] 

机构地区：[1]首都医科大学宣武医院综合科,北京100053

出　　处：《中华实用诊断与治疗杂志》2015年第5期462-464,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：卫生部行业科研专项项目基金(201002011);北京市保健科研课题项目基金(京11-13号)

摘　　要：目的探讨N末端B型利钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)、降钙素原(procalcitonin,PCT)在老年脓毒血症患者病情及预后评估中的作用。方法老年脓毒血症患者36例,依据病情分为脓毒血症组15例,严重脓毒血症组13例,脓毒性休克组8例。比较3组入院后NT-proBNP、PCT水平及急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分,并应用Pearson相关分析NT-proBNP、PCT与APACHEⅡ评分的相关性;记录患者28d生存情况。结果严重脓毒血症组NT-proBNP、PCT水平及APACHEⅡ评分分别为(1 898.32±479.17)ng/L、(13.67±3.14))μg/L、24.66±3.54,脓毒性休克组分别为(4 733.58±1 022.35)ng/L、(18.55±6.35)μg/L、28.15±3.22,均高于脓毒血症组[(1 071.84±101.69)ng/L、(7.17±1.92)μg/L、20.10±2.82](P<0.05),脓毒性休克组高于严重脓毒血症组(P<0.01);死亡患者NT-proBNP[(4 978.22±1 012.35)ng/L]、PCT[(19.16±7.14)μg/L]及APACHEⅡ评分(28.21±3.08)高于存活者[(2 144.25±967.65)ng/L、(14.95±3.07)μg/L、25.20±2.63],差异有统计学意义(P<0.05或P<0.01);NT-proBNP(r=0.465,P=0.029)、PCT(r=0.641,P=0.002)与APACHEⅡ评分均呈正相关。结论 NT-proBNP和PCT可作为老年脓毒血症患者病情评估及预后判断的生物学指标,其值越高,预后越差。Objective To explore the clinical significance of N-terminal pro-brain natriuretic peptide（NT-proBNP）and procalcitonin（PCT）in the evaluation of disease condition and prognosis in the elderly sepsis patients.Methods Thirtysix elderly patients with sepsis were divided into sepsis group（n=15）,severe sepsis group（n=13）and septic shock group（n=8）.NT-proBNP and PCT concentrations were measured,and Acute Physiology and Chronic Health EvaluationⅡ（APACHE Ⅱ）score was assessed after admission.All indicators of three groups were compared and the relationship of NT-proBNP and PCT with APACHE Ⅱ was analyzed by Pearsonanalysis.The survival was recorded in28 days.Results NT-proBNP,PCT and APACHEⅡ score were the highest in septic shock group（（4 733.58±1 022.35）ng/L,（18.55±6.35）μg/L,28.15±3.22）,followed by severe sepsis group（（1 898.32±479.17）ng/L,（13.67±3.14）μg/L,24.66±3.54）,and sepsis group（（1 071.84±101.69）ng/L,（7.17±1.92）μg/L,20.10±2.82）（P0.01）.NT-proBNP,PCT and APACHE Ⅱ score were（4 978.22±1 012.35）ng/L,（19.16±7.14）μg/L and28.21±3.08 in dead patients,significantly higher than those in survival patients（（2 144.25±967.65）ng/L,（14.95±3.07）μg/L,25.20±2.63）（P0.05,P0.01）.NT-proBNP（r=0.465,P=0.029）and PCT（r=0.641,P=0.002）were positively correlated with APACHE Ⅱscore.Conclusion NT-proBNP and PCT can be used as biomarkers for evaluating the disease condition and prognosis in elderly patients with sepsis.High levels of PCT and NT-proBNP might suggest a poor prognosis.

关 键 词：脓毒血症 N末端B型利钠肽原 降钙素原 预后 

分 类 号：R459.7[医药卫生—急诊医学]