感染性休克患者AVP-Time变化及AVP分泌调节异常对预后的预测价值和临床意义  

Prognostic value and clinical significance of AVP-time changes and abnormal regulation of AVP secretion in patients with septic shock

作　　者：张维华 宋昭光 温思聪 吴平宇 秦珊珊 ZHANG Weihua;SONG Zhaoguang;WEN Sicong;WU Pingyu;QIN Shanshan(Department of Critical Care Medicine,the People's Hospital of Tongcheng,Tongcheng Anhui 231400,China)

机构地区：[1]桐城市人民医院重症医学科,安徽桐城231400

出　　处：《中国急救复苏与灾害医学杂志》2024年第3期322-326,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省卫生厅医药科研计划项目(编号:12925KJ2017B17)。

摘　　要：目的探究感染性休克患者精氨酸血管加压素(AVP)浓度随病程变化情况及AVP分泌调节异常对感染性休克患者预后的预测价值。方法分析安徽省桐城市人民医院ICU的80例感染性休克患者资料,按照是否存在AVP分泌调节异常分为正常组(n=36)及异常组(n=44),按照28 d死亡情况分为死亡组(n=43)与生存组(n=37)。收集患者入院后成功诊断为感染性休克入ICU后1、6、12、24、36、48、72及96 h血浆AVP水平,绘制AVP浓度随时间变化曲线。比较感染性休克患者28d病死率及生存组与死亡组临床资料。采用logistic回归法分析感染性休克患者28 d预后危险因素。采用ROC曲线分析APACHEⅡ评分、BNP及AVP分泌调节情况诊断感染性休克患者28d预后的价值。结果感染性休克患者平均血浆AVP浓度呈现先升高后降低趋势。80例患者28 d死亡43例,死亡率为53.75%。logistic回归分析结果显示,年龄>60岁,APACHEⅡ评分>20分、BNP>13000 pg/mL及AVP分泌调节异常是感染性休克患者28 d死亡独立危险因素(P<0.05)。APACHEⅡ评分、BNP、AVP分泌调节情况及联合诊断的AUC值分别为0.794、0.728、0.677、0.858,均有显著诊断价值(P<0.05)。联合诊断优于BNP及AVP分泌调节情况单独诊断(P<0.05)。结论感染性休克患者AVP-Time呈现先上升后降低趋势,AVP分泌调节异常是感染性休克患者28 d死亡独立危险因素,且能有效预测患者预后。Objective To investigate the change of arginine vasopressin(AVP)concentration over the course of septic shock and the prognostic value of abnormal secretion regulation of AVP in patients with septic shock.Methods The data of 80 patients with septic shock admitted to the ICU of our hospital were analyzed.They were divided into a normal group(n=36)and an abnormal group(n=44)based on the presence of abnormal regulation of AVP secretion,and into a death group(n=43)and a survival group(n=37)based on 28-day mortality.Plasma AVP levels were collected at 1,6,12,24,36,48,72,and 96 hours after admission to the ICU,and the change curve of AVP concentration over time was drawn.The 28 day mortality and the clinical data of the survival group and the death group were compared.The logistic regression method was used to analyze the risk factors for the 28-day prognosis of patients with septic shock.The value of APACHEⅡscore,BNP,and AVP secretion regulation in the diagnosing 28-day prognosis of patients with septic shock was analyzed using ROC curves.Results The average plasma AVP concentration in patients with septic shock increased initially and then decreased.Of the 80 patients,43 died within 28 days,resulting in a mortality rate of 53.75%.Logistic regression analysis showed that age>60 years,APACHEⅡscore>20 points,BNP>13000 pg/mL and abnormal secretion of AVP were independent risk factors for 28 day mortality in patients with septic shock(P<0.05).APACHEⅡscore,BNP,regulation of AVP secretion and AUC value of combined diagnosis were 0.794,0.728,0.677,and 0.858,respectively,all of which had significant diagnostic value(P<0.05).The combined diagnosis was superior to the single diagnosis of BNP and regulation of AVP secretion(P<0.05).Conclusion The AVP-Time of patients with septic shock showed an initial increase followed by a decrease,and abnormal secretion of AVP is an independent risk factor for 28 day mortality in patients with septic shock,and can effectively predict patient prognosis.

关 键 词：感染性休克 AVP-Time AVP 预后 

分 类 号：R631.4[医药卫生—外科学]