N末端脑钠肽前体对脓毒症休克患者左心室舒张功能障碍的预测价值  

The value of serum N-terminal pro brain natriuretic peptide in predicting left ventricular diastolic dysfunction in septic shock patients

作　　者：沈林霞[1] 郑亚安[1] 田兆兴[1] 

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中华急诊医学杂志》2018年第2期164-167,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（81172745）

摘　　要：目的探讨血清N末端脑钠肽前体（N-terminal pro brain natriuretic peptide,NT-proBNP）对脓毒症休克患者发生左心室舒张功能障碍的预测价值。方法回顾性分析北京大学第三医院急诊科入院24h内出现脓毒症休克的患者96例，根据是否出现左心舒张功能障碍（left ventricular diastolic dysfunction,LVDD）,分为LVDD组（51例）和非LVDD（45例1组，记录患者一般临床资料以及入院24h内急性生理与慢性健康评分（APACHEII评分）、NT-proBNP、肌钙蛋白I（troponin I,TNI）、血肌酐、降钙素原、D-二聚体及乳酸值，比较两组间的临床资料；用多因素Logistic回归法分析脓毒症休克并发左心室舒张功能障碍的独立危险因素，绘制受试者工作特征曲线（ROC曲线）评价NT-proBNP的预测价值。结果与非LVDD组比较，LVDD组NT-proBNP[IgNT-proBNP（3．66±0．38）与（3．03±0．59），P〈0．01]、TNI[1gTNI（-1．45±0．86）与（-2．36±0．82），P〈0．01]和肌酐[（186．12±124．24）与（101．16±57。01），P=0．001]水平升高，差异均有统计学意义；NT-proBNP、TNI、肌酐与二尖瓣口舒张早期血流速度峰值与二尖瓣环舒张早期运动速度之比成正相关（P〈0．05）；多因素logistic回归分析显示，NT-proBNP[优势比（OR）=8．731，95％可信区间（95％a）1。541～49．466，P=0．0141是脓毒症休克患者发生左心室舒张功能障碍的独立危险因素；ROC曲线显示，NT-proBNP值为1725pg／uL时预测脓毒性休克致左心舒张功能障碍发生的曲线下面积为O．813，敏感度为88．6％，特异度为62．1％。结论NT-proBNP对脓毒症休克患者并发左心室舒张功能障碍有较好的预测价值。Objective To investigate the predictive value of serum N-terminal pro brain natriuretic peptide NT-proBNP in left ventricular diastolic dysfunction（LVDD） in septic shock patients. Methods According to retrospective analysis of clinical data 96 patients with septic shock were divided into LVDD group and non-LVDD group. General clinical data, APACHE scores, NT-proBNP, Troponin I（TNI）,creatinine, procalcitonin, D-dimer and lactic acid within the first 24 hours after admission were recorded, and multi-factors logistic regression analysis was conducted to find independent risk factors for left ventricular diastolic dysfunction in septic shock patients Receiver operating characteristic curve ROC was constructed to indicate the predictive value. Results There were no significant differences in general clinical data, procalcitonin, D-dimer and lactic acid between two groups. Compared with non-LVDD group the levels of NT-proBNP [lgNT-proBNP （3.66±0.38） vs.（3.03±0.59）,P =0.000],TNI [lgTNI（-1.45±0.86 ）vs.（-2.36±0.82）, P 〈 0.01] and creatinine [（186.12±124.24）vs.（101.16±57.01）, P 〈 0.01] in LVDD group were significantly higher .It was shown by multi-factors logistic regression analysis that NT-proBNP （0R=8.731, 95%CI, 1.541-49.466, P=0.014） was an independent risk factor for left ventricular diastolic dysfunction in septic shock patients. The area under the curve AUC of NT-proBNP was 0.813 with the cut-off value of 1 725 pg/μL, sensibility = 88.6%, specificity =62.1%. Conclusion NT-proBNP was avaluable indicator in predicting left ventricular diastolic dysfunction in septic shock patients.

关 键 词：脓毒症 脓毒症休克 左心室舒张功能障碍 N末端脑钠肽前体 肌钙蛋白I 肌酐 二尖瓣口舒张早期血流速度峰值 二尖瓣环舒张早期运动速度 

分 类 号：R459.7[医药卫生—急诊医学]