脓毒性休克患者血清C-反应蛋白、降钙素原和NT-pro-BNP水平及预后意义  

Serum C-reactive protein, procalcitonin and NT-pro-BNP levels in patients with septic shock and their prognostic significance

作　　者：张颖[1] 袁杉[2] 汪阳[3] ZHANG Ying;YUAN Shan;WANG Yang(Department of Critical Care Medicine, Xi'an Central Hospital, Xi'an 710003, China)

机构地区：[1]西安市中心医院重症医学科,西安710003 [2]西安市中心医院肾病科,西安710003 [3]西安市中心医院烧伤整形科,西安710003

出　　处：《空军医学杂志》2018年第1期52-56,共5页Medical Journal of Air Force

基　　金：陕西省自然科学基金项目(2004C2-28)

摘　　要：目的脓毒性休克患者血清C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)和血清氨基末端脑钠肽前体(N-terminal-pro BNP,NT-pro-BNP)水平及预后意义。方法选取2010年1月—2016年5月西安市中心医院收治的80例脓毒症患者及同期40例体检正常者作为研究对象,采用系统性回顾法分析其临床及随访资料,80例脓毒症患者分为脓毒症未休克组(A组)48例和脓毒性休克组(B组)32例,根据脓毒性休克组中是否死亡分为脓毒性休克非死亡组(C组)20例和脓毒性休克死亡组(D组)12例,将40例正常者作为对照组。记录所有纳入研究者的一般临床资料,并比较不同患者间CRP、PCT、NT-pro-BNP、白介素-6(interleukin-6,IL-6)和肿瘤坏死因子α(tumor necrosis factor,TNF-α)水平及其之间的相关性,通过非条件单因素及多因素Logistic回归模型分析上述指标对脓毒性休克患者预后的影响。结果脓毒症患者其CRP、PCT、NT-pro-BNP、IL-6和TNF-α水平均明显高于对照组,且脓毒性休克患者较脓毒症未休克者高,脓毒性休克死亡患者更明显高于脓毒性休克非死亡者,差异间均具有统计学意义(P<0.05);通过非条件单因素Logistic回归模型分析可得,菌血症(感染部位为血液)、APACHEⅡ评分及CRP、PCT、NT-pro-BNP、IL-6和TNF-α的表达水平可能为影响脓毒性休克患者预后的主要因素(P<0.05);通过Spearman等级相关分析可得,APACHEⅡ评分与CRP、PCT、NT-pro-BNP、IL-6及TNF-α之间呈正相关(P<0.05),CRP、PCT、NT-pro-BNP、IL-6及TNF-α之间均呈正相关(P<0.05);通过非条件多因素Logistic回归模型分析可得,CRP、PCT和NT-pro-BNP为影响脓毒性休克患者预后的独立危险因素(P<0.05)结论脓毒性休克患者CRP、PCT和NT-pro-BNP水平较正常者显著升高,为影响脓毒性休克患者预后的独立危险因素,随着他们水平的升高,脓毒性休克患者其预后越差,可作为临床上评估脓毒症病情严重程度及脓毒�Objective To investigate the serum levels of C-reactive protein(CRP),procalcitonin(PCT)and serum pro-brain natriuretic peptide(NT-pro-BNP)in patients with septic shock and their prognostic significance.Methods Eighty patients with sepsis admitted to our hospital between January2010and May2016and another forty patients with normal results of physical examinations(the control group)were enrolled in the investigation.The clinical and follow-up data was analyzed by systematic review.The eighty patients included48patients without septic shock(Group A)and32patients with septic shock(Group B).Group B was further divided into the non-death group(Group C)with20cases and the death group(Group D)with12cases according to the occurrence of death.The levels of serum CRP,PCT,NT-pro-BNP,interleukin-6(IL-6)and tumor necrosis factor(TNF-α)were measured and compared between these groups.Univariate and multivariate logistic regression models were used to analyze the effect of these parameters on the prognosis of patients with septic shock.Results The levels of CRP,PCT,NT-pro-BNP,IL-6and TNF-αin sepsis patients were significantly higher than those of the control,and these levels were the highest in Group B.The difference was statistically significant(P<0.05)Bacteremia,APACHEII score,CRP,PCT,NT-pro-BNP,IL-6and the expression level of TNF-alpha might have been the main factors that affected the prognosis of patients with septic shock according to the single factor non-conditional logistic regression analysis(P<0.05).The expressions of APACHEⅡ,CRP,PCT,NT-pro-BNP,IL-6and TNF-αwere positively correlated(P<0.05),CRP,PCT,NT-pro-BNP,IL-6and TNF-αwere positively correlated(P<0.05).CRP,PCT and NTpro-BNP were independent risk factors for the prognosis of patients with septic shock(P<0.05).Conclusion The levels of CRP,PCT and NT-pro-BNP in patients with septic shock are significantly higher than those in normal controls and are independent risk factors for the prognosis of patients.With the increase of these levels,the prognosis of patient

关 键 词：脓毒性休克 血清C-反应蛋白 降钙素原 血清氨基末端脑钠肽前体 

分 类 号：R631[医药卫生—外科学]