心肌脂肪酸结合蛋白在脓毒症临床预后的预测价值研究  

Value of heart-type fatty acid-binding protein in predicting prognosis of patients with sepsis

作　　者：李丹丹[1] 李雯莉[1] 高冉冉[1] 彭鹏[1] 杨建中[1] 

机构地区：[1]新疆医科大学第一附属医院急诊科,乌鲁木齐830011

出　　处：《中华急诊医学杂志》2016年第11期1443-1448,共6页Chinese Journal of Emergency Medicine

摘　　要：目的探讨心肌脂肪酸结合蛋白（heart-typefattyacid—bindingprotein，H—FABP）在脓毒症患者临床预后的预测价值，提高脓毒症患者救治率。方法采用前瞻性病例对照研究，纳入2014年10月至2015年10月就诊于新疆医科大学第一附属医院脓毒血症患者共50例，根据2012年脓毒症诊疗指南分为脓毒症组（16例）、严重脓毒症组（14例）、脓毒性休克组（20例）；根据28d后是否存活分为死亡组（22例）与存活组（28例）。记录性别、年龄、族别等基本资料，入急诊6h内完善急性生理与慢性健康状况（APACHEU）评分，H—FABP，B型脑钠利肽（B—type natriuretic，BNP）、肌酸激酶（creatinekinase，CK）、肌酸激酶同工酶（creatine kinase isoenzymes，CK．MB）、肌钙蛋白（troponin-T，cTn-T）等指标。统计学采用SPSS21．0软件，计量资料t检验或秩和检验、计数资料采用x2检验，非正态分布资料采用秩合检验，对生存状况进行ROC曲线分析。结果脓毒性休克组的H—FABP明显高于严重脓毒症组和脓毒症组（P〈0．01）。脓毒性休克组28天死亡率（80％）与严重脓毒症组28d病死率高于脓毒症组28天死亡率（12．5％）（P〈0．01）。死亡组H—FABP、BNP、eTn-T、CK、CK—MB均明显高于存活组，两组间差异具有统计学意义（P〈0．05）；对H-FABP和BNP行ROC曲线结果提示H—FABP（AUC=0．748，P=0．003，95％CI：0．605～0．890）优于BNP（AUC=0．714，P=0．010，95％CI：0．573～0．856），当H-FABP取9．902ng／mL，敏感度82．1％，特异度63．6％。H-FABP对28d病死率的预测具有一定价值。结论脓毒性休克组病死率明显高于严重脓毒血症及脓毒症组。H-FABP相比BNP、CK、CK-MB，对脓毒症患者预后具有较大的预测价值，随病情加重而增高。H—FABP可以预测28d病死率。Objective To study the predictive value of heart-type fatty acid-binding protein （H- FABP） in the improvement of survival rate in patients with severe sepsis. Methods There was a prospective ease-control study in 50 patients with severe sepsis from October 2014 to October 2015. According to the international guidelines for severe sepsis and septic shock set in 2012, all patients were divided into sepsis group （n = 16）, severe sepsis group （n = 14） and septic shock group （n = 20）, and these patients were further divided into to survival group （ n = 22 ） and non-survival group （ n = 28 ） as per patients surviving within 28 days. Gender, age, ethnic, and Acute Physiology and Chronic Health Evaluation score （APACHE II ） were recorded. H-FABP, B-type natriuretic peptide （BNP）, creatine kinase （CK）, creatine kinase isoenzyme （CK-MB）, and troponin-T （cTn-T） were determined within 6 hours after admission. The statistical software SPSS21.0 was used to do t test, test, and the receiver operating characteristic curve for comparison between groups. Results H-FABP in septic shock group was higher than severe sepsis group and sepsis group （P 〈0. 01 ）. The 28-day mortality of septic group （80%） and severe sepsis group （71.4%） were higher than sepsis group （12. 5% ） （P 〈 O. O1 ）. Non-survival＇ s H-FABP, BNP, cTn-T , CK, CKMB was higher than survivals （ P 〈 0. 05 ）. Through the ROC of H- FABP （AUC=0.748, P=0.003, 95%CI： 0.605 -0.890） and BNP （AUC =0.714, P=0.010, 95% CI： O. 573 -0. 856）, it shows that H-FABP is better than BNP. when H-FABP take 9. 902 ng/mL, the sensitivity of 82. 1%, specificity of 63.6%. H-FABP, BNP has a certain value in 28-day mortality prediction. Conclusions Sepsis shock has significantly higher 28-day mortality than sepsis and severe sepsis. Compared with BNP, H-FABP has greater predictive value in sepsis patients, it will increase along with the aggravation of the disease; it can also predict 28-day mortality.

关 键 词：脓毒血症 心肌脂肪酸结合蛋白 B型脑钠肽 28 d病死率 预后 

分 类 号：R459.7[医药卫生—急诊医学]