多种生物标志物在脓毒症患者中的临床价值  

The clinical value of biomarkers in patients with sepsis

作　　者：郭金玲[1] 张长春[1] 贾晓君[1] 李雅廉 

机构地区：[1]中国人民解放军第306医院重症监护病房,北京100101

出　　处：《临床急诊杂志》2017年第11期826-829,共4页Journal of Clinical Emergency

摘　　要：目的:通过联合检测脓毒症患者血浆氨基末端脑钠肽前体(NT-proBNP)、降钙素原、乳酸及胆碱酯酶的质量浓度,研究其对脓毒症患者病情评估及预后判断的临床意义。方法:用前瞻性研究方法,以2015-01-2017-06期间在我院重症监护室住院的120例脓毒症患者为研究对象。其中一般脓毒症组51例,严重脓毒症组40例,脓毒症休克组29例。对3组患者不同时间NT-proBNP、降钙素原、乳酸及胆碱酯酶质量浓度水平变化进行比较分析,并行APACHEⅡ评分。随访严重脓毒症及脓毒症休克组患者28d生存情况,对存活组(50例)及死亡组(19例)患者的各项指标进行比较,并比较NT-proBNP、降钙素原、乳酸、胆碱酯酶与APACHEⅡ评分的相关性。结果:与脓毒症组患者相比,严重脓毒症组和脓毒症休克组患者在不同时间血浆NT-proBNP、降钙素原、乳酸水平明显提高,而胆碱酯酶明显降低,3组间比较差异均具有统计学意义(P<0.05);与严重脓毒症组相比,脓毒症休克组患者在不同时间血浆NT-proBNP、降钙素原、乳酸水平明显提高,而胆碱酯酶明显降低,3组间比较差异均具有统计学意义(P<0.05);与存活组相比,死亡组血浆NT-proBNP、降钙素原、乳酸质量浓度及APACHEⅡ评分均明显提高,而胆碱酯酶水平明显降低,差异具有统计学意义(P<0.05);血浆NT-proBNP、降钙素原、乳酸质量浓度与APACHEⅡ评分呈正相关,胆碱酯酶的质量浓度与APACHEⅡ评分呈负相关。结论:血浆NT-proBNP、降钙素原、乳酸、胆碱酯酶联合检测对于脓毒症患者预后的评估具有重要的临床指导意义。Objective：To evaluate the clinical significance for assessment and prognosis of patients with sepsis by way of detecting plasma N-terminal brain natriuretic peptide,procalcitonin,blood lactate and cholinesterase levels.Method：It was a prospective trial conducted.A total of 120 patients with sepsis were admitted to the intensive care unit from January 2015 through June 2017.Of them,there were 51 patients with mild sepsis,40 petients with severe sepsis,and 29 patients with septic shock.The levels of N-terminal brain natriuretic peptide,procalcitonin,blood lactate and cholinesterase at different time in the three groups were compared and analyzed.The APACHEⅡscore was also determined.In the following 28 days,the survival of patients with severe sepsis and septic shock were investigated.Data of laboratory findings were analyzed for comparison between the survival group（n=50）and death group（n=19）.Result：Compared with sepsis group,the levels of N-terminal brain natriuretic peptide,procalcitonin,blood lactate in severe sepsis group and septic shock group at different time were increased significantly,but the levels of cholinesterase were decreased.The differences among three groups were statistically significant（P0.05）.Compared with severe sepsis group,the levels of N-terminal brain natriuretic peptide,procalcitonin,blood lactate in septic shock group at different time were increased significantly,but the levels of cholinesterase were decreased.The differences among three groups were statistically significant（P0.05）.In addition,compared with survival group,the levels of N-terminal brain natriuretic peptide,procalcitonin,blood lactate in the death group were increased significantly,but cholinesterase were decreased obviously,the differences were statistically significant（P0.05）.The plasma levels of N-terminal brain natriuretic peptide,procalcitonin,blood lactate and the APACHEⅡ score were positively correlated,but the plasma levels of cholinesterase and the APACHEⅡscore were negatively corr

关 键 词：脓毒症 脓毒症休克 预后 氨基末端脑钠肽前体 降钙素原 血乳酸 胆碱酯酶 

分 类 号：R631[医药卫生—外科学]