血清利钾尿肽对严重脓毒症患者并发心房颤动及预后的预测价值  

Predictive value of the serum kaliuretic peptide in patients with severe sepsis concurrency atrial fibrillation and prognosis

作　　者：姚志军[1] 陈兴旺[1] 周华锋[1] 陈后旺[1] 吴华初 李钊[1] 赖剑波[1] 

机构地区：[1]广州医科大学附属深圳沙井医院重症医学科,518104

出　　处：《中国综合临床》2016年第5期407-411,共5页Clinical Medicine of China

摘　　要：目的探讨严重脓毒症患者的血清刊钾尿肽（KP）水平对并发心房颤动（AF）及预后的预测价值。方法收集2014年1月至2015年8月入住我院综合ICU的56例严重脓毒症患者作为研究组，另外选取同期健康体检者20名作为对照组，研究组患者入院后1周内每天采血检测血清KP，同时进行APACHE-Ⅱ评分，根据心电监护和心电图是否发生AF分为AF组和非AF组，分析28d后存活组和死亡组血清KP与AF和预后的关系，对照组于体检当天采血检测血清KP。结果（1）56例严重脓毒症患者AF的发生率为32．1％（18／56）。（2）研究组入院时血清KP显著高于对照组[（234．2±73．5）、（169．6±65．4）pmol／L]，差异有统计学意义（t=3．47，IP〈0．001）；AF组入院时的血清KP显著高于非AF组[（306．0±35．6）、（200．2±61．2）pmol／L]，差异有统计学意义（t=6．79，P〈0．001）；AF组发生AF前1d的血清KP显著高于入院当天[（339．2±30．5）、（306．0±35．6）pmol／L，P=0．007]，发生AF当天的血清KP又显著高于AF发生前1d[（390．6±47．8）、（339．2±30．5）pmol／L，P=0．006]，AF发生后1d的血清KP则与AF发生当天差异无统计学意义（P=0．246），但开始呈下降趋势。死亡组19例，入院时的血清KP和APACHE-Ⅱ评分均显著高于存活组[（301．1±42．0）、（199．8±61．5）pmol／L，（26．1±2．8）、（19．9±4．3）分，t值分别为6．44、5．67，P均〈0．001]。（3）线性相关分析显示入院时的血清KP与AF的发生呈正相关（r=0．679，JP=0．010），以AF分组、入院时的血清KP水平绘制ROC曲线，血清KP的AUC为0．908（95％C10．831～0．984），当KP取值为351．5pmol／L时，发生AF的敏感性为89．9％，特异性为97．4％。（4）线性相关分析显示入院时的血清KP与死亡呈正相关（r=0．659，P=0．010），以顶后分组、人院时的血清KP和APACHE-Ⅱ评分绘制ROC曲�Objective To evaluate the value of serum kaliuretic peptide （KP） in predicting atrial fibrillation（AF） and its prognosis, by detecting serum KP levels in patients with severe sepsis. Methods Fifty- six patients with severe sepsis in Integrated Intensive Care Unit of Shajing Hospital of Shenzhen Affiliated to Guangzhou Medical University from January 2014 to August 2015 were collected as the case group. In addition 20 cases health checkup for the same period were collected as the control group. Serum KP were determined in all patients in the case group every day for 1 week after admission, meanwhile the APACHE-Ⅱ score was undertook,then according to heart guardianship and electrocardiogram whether occurrence of AF the case group were divided into AF group and non AF group. According to survival after 28 days again divided into survival group and death group, the relationship of serum KP with AF and the prognosis were analyzed. Serum KP was detected on the day of physical examination in the control group. Results （ 1 ） The incidence of AF was 32. 1% （18/56） in 56 patients with severe sepsis. （2）Serum KP in admission to hospital in case group was significantly higher than that in the control group（ （234. 2±73.5） pmol/L vs. （ 169. 6±65.4） pmol/L;t= 3.47,P =0. 001）. Serum KP in admission to hospital in AF group was significantly higher than that in the non AF group （ （ 306. 0±35.6） pmol/L vs. （200. 2±61.2） pmol/L;t= 6. 79,P=0. 001）. Serum KP in AF group before 1 day of the occurrence AF was significantly higher than of the admission to hospital （ （339.2 ± 30. 5 ） pmol/L vs. （306.0 ±35.6） pmol/L;P=0. 007） ,serum KP on the day of occurrence AF was significantly higher than before 1 days of the occurrence AF（ （390. 6±47. 8） pmol/L vs. （339. 2±30. 5） pmol/L;P= 0. 006） ,there was no difference between the serum KP after 1 days of occurrence AF and on the day of occurrence AF（P=0. 246） ,but began to gradually declining. Serum KP and APACHE- �

关 键 词：脓毒症 利钾尿肽 心房颤动 预后 

分 类 号：R459.7[医药卫生—急诊医学] R541.75[医药卫生—治疗学]