N端B型脑钠肽在脓毒症诊断中的价值  

The diagnosis value of N-terminal brain natriuretic peptide in sepsis

作　　者：刘鸿[1] 李燕[1] 卢彩兰[1] 

机构地区：[1]山西医科大学第二医院,山西太原030001

出　　处：《临床医药实践》2017年第10期730-733,共4页Proceeding of Clinical Medicine

摘　　要：目的:探讨N端B型脑钠肽(NT-proBNP)在脓毒症诊断和预后评估中的价值。方法:选择2013年4月—2014年3月收治的急性感染患者62例,根据脓毒症诊断标准将患者分为一般感染组(9例)和脓毒症组(53例),再根据脓毒症的严重程度将脓毒症组分为脓毒症组(23例)、严重脓毒症组(22例)和脓毒性休克组(8例)3个亚组。于入院24 h内取静脉血,检测NT-proBNP水平,并进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。采用单因素方差分析比较各组NT-proBNP水平与APACHEⅡ评分的差异;采用Pearson相关性分析法,分析NT-proBNP水平与APACHEⅡ评分的相关性;采用受试者工作特征曲线(ROC)评估NT-proBNP对脓毒症的诊断价值。结果:一般感染组、脓毒症组、严重脓毒症组和脓毒性休克组患者血浆NT-proBNP水平和APACHEII评分呈依次增高,且各组间比较,差异均有统计学意义;Pearson相关性分析结果显示:NT-proBNP水平和APACHEⅡ评分呈显著正相关(r=0.364,P<0.01);ROC曲线分析显示:NT-proBNP诊断严重脓毒症和脓毒症休克的ROC曲线下面积(AUC)为0.779(P=0.003)。截断值为333.50 pg/L时,敏感度为80%,特异度为59.4%,阳性预测值为0.80,阴性预测值为0.76。结论:血浆NT-proBNP水平可作为脓毒症患者诊断病情严重程度和预后评估的指标。Objective： To explore the diagnosis and prognosis evaluation value of N-terminal brain natriuretic peptide（ NT-proBNP） in sepsis. Methods： A total of 62 patients with acute infection were enrolled for this study in the Second Hospital of Shanxi Medical University between April 2010 and March 2014. According to the diagnostic criteria of sepsis,the patients with acute infection were divided into general infection group（ 9 cases） and sepsis group（ 53 cases）. According to sepsis severity,the latter group was divided into three subgroups： sepsis group（ 23 cases）,severe sepsis group（ 22 cases） and sepsis shock group（ 8 cases）. All the research objects in hospital were taken venous blood within 24 h. We detected the levels of NT-proBNP in each groups. Acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） score was done in each groups.We used single factor analysis of variance to compare the difference of the NT-proBNP level and APACHE Ⅱ score between the groups. The relationships between NT-proBNP and APACHE Ⅱ score were determined with Pearson correlation analysis.The receiver-operating characteristic curves（ ROC） of NT-proBNP were used to evaluate the diagnosis ability in severe sepsis and sepsis shock. Results： The levels of NT-proBNP and APACHEⅡscore of the general infection group,sepsis group,severe sepsis group and sepsis shock group increased in turn. Comparative differences between groups were statistically significant（P〈0. 05）. Pearson correlation analysis results showded that the levels of NT-proBNP and APACHE Ⅱ scores is significantly positive related（ r = 0. 364,P〈0. 01）. The area under the ROC curve（ AUC） of the NT-proBNP in the diagnosis of severe sepsis and sepsis shock was 0. 779（ P = 0. 003）. When the cutoff value was 333. 50 pg/L,the sensitivity was 80. 0%,the specificity was 59. 4%,the positive predictive value was 0. 80 and the negative predictive value was 0. 76. Conclusion： The plasma levels of NT-proBNP can be used as

关 键 词：N端B型脑钠肽 脓毒症 急性生理学与慢性健康状况评分系统Ⅱ评分 

分 类 号：R765.42[医药卫生—耳鼻咽喉科]