B型尿钠肽和可溶性尿激酶型纤溶酶原激活物受体预测重症监护病房患者血流感染的价值  

The clinical value of brain natriuretic peptide and soluble urokinase plasminogen activator receptor in the diagnosis and prognosis of bloodstream infection in the patients of Intensive Care Unit

作　　者：孙海伟[1] 刘励军[1] 马丽梅 朱建军[1] 赵旭明[1] 周保纯[1] Sun Haiwei;Liu Lijun;Ma Limei;Zhu Jianjun;Zhao Xuming;Zhou Baochun(Intensive Care Unit, the Second Hospital Affiliated to Suzhou University, Suzhou 215000, China)

机构地区：[1]苏州大学附属第二医院ICU,215000

出　　处：《中华急诊医学杂志》2019年第3期356-360,共5页Chinese Journal of Emergency Medicine

摘　　要：目的研究B型尿钠肽( brain natriuretic peptide, BNP )和可溶性尿激酶型纤溶酶原激活物受体(soluble urokinase plasminogen activator receptor, suPAR )在血流感染的诊断和预后评估中的临床应用价值.方法选取2016年1月至2017年12月苏州大学附属第二医院重症监护病房(intensive care unit, ICU )收治的165例疑似血流感染患者,根据血流感染的诊断标准,将患者分为血流感染感染组和非血流感染组。根据患者的预后又将血流感染组分成生存组和死亡组。检测患者血清suPAR、 BNP、 C反应蛋白(C-reactive protein, CRP )和降钙素原(procalcitonin, PCT)的水平,急性生理学与慢性健康状况评分系统Ⅱ( APACHE Ⅱ)评分,患者的预后状况。分析患者血清suPAR、BNP、 CRP、PCT水平及APACHE Ⅱ评分与预后(死亡情况)的关系,通过受试者工作特征曲线(ROC)和曲线下面积(AUC),评估血清suPAR、BNP、CRP、PCT , APACHE Ⅱ对血流感染早期诊断及预测预后的能力。结果血流感染患者血清suPAR,BNP、 CRP、PCT及APACHE II评分水平均高于非感染组患者(均P<0.05 );死亡组患者的血清suPAR、 BNP、 CRP、PCT 及 APACHE Ⅱ评分水平均高于存活组(均P<0.05 )。预后结果表明,血流感染患者血清suPAR 、 BNP、PCT与APHCHE Ⅱ评分之间呈正相关(r=0.503, 0.548, 0.781,均P<0.05),由ROC曲线分析结果发现,血清suPAR、 BNP、PCT及APACHE Ⅱ评分水对患者的预后均有较好的评估作用:结论检测血流感染患者血清suPAR 、 BNP水平可以较好地评估血流感染的严重程度,并能够初步评估血流感染患者的预后,值得推广使用。Objective To study the clinical value of brain natriuretic peptide (BNP) and soluble urokinase plasminogen activator receptor (suPAR) in the diagnosis and prognosis of bloodstream infection. Methods Totally 165 patients suspected of bloodstream infection admitted in intensive care unit (ICU) of the Second Hospital Affiliated to Suzhou University were enrolled in this study. According to the diagnosis standard of bloodstream inflection, patients were divided into the bloodstream infection group and nonbloodstream infection group. According to the prognosis of the patients, the bloodstream infection group was further divided into the survival group and the death group. Serum levels of suPAR, BNP, CRP, PCT, and chronic health evaluation Ⅱ acute physiology score (APACHE Ⅱ), and mortality of the patients were analyzed, and the possible relation of the above indexes between the two groups were compared. Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC), the early diagnostic value of suPAR, BNP, CRP, PCT, and APACHE H score in the bloodstream infection patients was determined. Results Serum levels of suPAR, BNP, CRP, PCT and APACHE Ⅱ score in the bloodstream infection group were higher than those in the non-bloodstream infection group (P<0.05);Serum levels of suPAR, BNP, CRP, PCT and APACHE Ⅱ score in the death group were higher than those in the survival group (P<0.05). There was a positive correlation between serum suPAR, BNP, PCT and APHCHE H score in patients of bloodstream infection(r=0.503, 0.548 0.781,all P<0.05). The levels of suPAR, BNP, PCT and APACHE Ⅱ in the patients of blood stream infection were related to significant the prognosis (P<0.05). And these indexes can provide good evaluation on the prognosis of the patients. Conclusion Detection of serum suPAR, BNP can evaluate the severity of bloodstream infection and preliminarily determine the prognosis of patients with bloodstream infection. Therefore, the method is worth applying in the clinical field.

关 键 词：血流感染 可溶性尿激酶型纤溶酶原激活物受体 B型尿钠肽 APACHE Ⅱ评分 

分 类 号：R459.7[医药卫生—急诊医学]