血清PCT、BNP水平预测脓毒症休克患者容量反应性的价值  

Values of serum PCT and BNP levels in predicting volume reactivity in patients with septic shock

作　　者：高勇[1] 于娣[2] 王晓静[3] 王钧[4] GAO Yong;YU Di;WANG Xiaojing;WANG Jun(Department of Respirotory Medicine and Critical Care Medicine No 1,Hebei Chest Hospital,Shijiazhuang Hebei 050017,China)

机构地区：[1]河北省胸科医院呼吸与危重症一科,河北石家庄050017 [2]河北省胸科医院危重症医学科,河北石家庄050017 [3]河北省胸科医院呼吸与危重症医学二科,河北石家庄050017 [4]河北省胸科医院急诊科,河北石家庄050017

出　　处：《中国急救复苏与灾害医学杂志》2022年第5期607-610,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省医学科学研究重点课题计划项目(编号:ZD20140378);河北省医学科学研究重点课题计划项目(编号:20210114)。

摘　　要：目的探讨血清降钙素原(PCT)、脑钠肽(BNP)水平预测脓毒症休克患者容量反应性的临床价值。方法选取河北省胸科医院2019年3月—2021年6月110例脓毒症休克患者作为研究对象,根据容量负荷试验将患者分为有反应组[心输出量(CO)或每搏输出量(SV)较实验前升高≥15%,67例]和无反应组(CO和SV较实验前升高<15%,43例)。于容量负荷试验前测定两组患者血清PCT、BNP水平,借助ROC分析血清PCT、BNP水平对脓毒症休克患者有容量反应性的预测价值,通过一致性分析,评估PCT联合BNP对脓毒症休克患者有容量反应性的预测价值。结果有反应组PCT、BNP水平均显著低于无反应组,比较差异有统计学意义(P<0.05)。经ROC分析,血清PCT、BNP水平预测脓毒症休克患者有容量反应性的曲线下面积分别为0.940、0.933,均有P<0.05。经一致性分析,110例脓毒症休克患者中联合预测阳性有66例,敏感度为0.985,特异性为0.930,准确率为0.964,Kappa为0.923。结论血清PCT、BNP水平均可用于脓毒症休克患者容量反应性的预测中,且联合检测可获得更好的敏感度、特异性,有临床推广价值。Objective To explore the clinical values of serum procalcitonin(PCT)and brain natriuretic peptide(BNP)in predicting volume reactivity in patients with septic shock.Methods 110 patients with septic shock were divided into 2 groups according to the volume load test:reactive group[with the cardiac output(CO)or stroke output(SV)increased by≥15%,67 cases]and non-reactive group(with the CO or SV increased by<15%,43 cases).Fasting peripheral venous blood samples were collected before the volume load test to measure the levels of serum PCT and BNP.The predictive values of serum PCT and BNP levels in predicting volume reactivity was analyzed by ROC,and consistency analysis was conducted to evaluate the predictive value of PCT combined with BNP on the volumetric reactivity.Results The levels of PCT and BNP of the reactive group were both significantly lower than those of the non reactive group(both P<0.05).ROC analysis showed that the areas under the curve of serum PCT and BNP levels predicting volumetric reactivity in patients with septic shock were 0.940 and 0.933 respectively combined positive results of PCT and BNP,with the value of sensitivity as 0.985,of specificity as 0.930,of accuracy as 0.964 and the kappa value as 0.923.Conclusion The levels of serum PCT and BNP can be used to predict the volume response of patients with septic shock,and the combined detection,with higher sensitivity and specificity,has better clinical value.

关 键 词：降钙素原 脑钠肽 脓毒症休克 容量反应性 容量负荷试验 

分 类 号：R631[医药卫生—外科学]