摘要
目的探讨动态监测脓毒性休克患者的血浆B型脑钠肽前体（Pro—BNP）浓度对脓毒性休克心功能抑制程度和患者预后的评估作用。方法测定102例脓毒性休克患者第1、3、5天血浆Pro-BNP浓度，根据28d存活情况分为存活组和死亡组，按血流动力学指标分为心功能减低组（CI〈3．0）和心功能正常组（CI≥3．0），分析其在各组之间的差异，并统计ICU病死率及28d病死率，分析Pro—BNP浓度对临床结局的预测价值。结果28d存活组人院第1、3、5天的血浆Pro-BNP浓度呈明显下降趋势[（1649．0±257．5）、（1867．6±291．7）、（1229．9±194．5）ng／L]，而死亡组患者血浆Pro—BNP浓度则呈上升趋势[（4128．8±1051．1）、（5315．9±925．4）、（6899．9±1327．9）ng／L]，两组第1、3、5天的血浆Pro—BNP浓度比较差异均有统计学意义（t值分别为3．057、5．083、6．290，P均〈0．01）；心功能正常组患者28d病死率和人院第1、3、5天的Pro—BNP浓度明显低于心功能减低组[28d病死率：62．1％与20．0％；（1592．8±362．2）与（4556．6±732．7）ng／L，（2933．6±421．7）与（5768．5±793．7）ng／L，（3014．5±587．5）与（8873．9±1670．1）ng／L]（x2=20．635，P=0．000，t值分别为．3．626、3．154、3．310，P均〈0．01）。以入院第5天的Pro—BNP浓度〉3053ng／L作为预测28d病死率的临界点，其敏感度为88．4％，特异度为91．5％；以入院第5天的Pro-BNP浓度〉2378ng／L作为预测住院病死率的临界点，其敏感度为84．9％，特异度为91．8％。多因素分析显示对于28d病死率APACHEII评分及第5天的Pro—BNP浓度是独立预测因素，第5天的Pro—BNP浓度是预测住院病死率的独立预测因素。结论动态监测血浆Pro-BNP浓度可以评价脓毒性休克患者的心脏抑制程度，入院第5天Pro—BNP浓度可以预测脓毒性休克患者的预后。
Objective To assess the effects of dynamic monitoring of plasma Pro-B-type Natriuretic Peptide（Pro-BNP） in the evaluation of prognostic value and myocardial dysfunction in patients with septic shock. Methods The levels of plasma Pro-BNP were tested in 102 patients with septic shock on the 1,3, and 5 days. Data on ICU mortality and 28-day mortality were collected. The patients were divided into non-dysfunction group （ CI 〈3.0） and cardiac dysfunction group （CI≥3.0） according to levels of hemodynamic variables （ CI level）. The prognostic value of plasma Pro-BNP was analyzed. Results Plasma Pro-BNP levels on the 1,3 and 5 days in 28-day survivors have a significant declining trend [ （ 1649. 0±257.5 ） ng/L, （ 1867.6 ± 291.7 ） ng/L vs. （1229. 9± 194. 5 ） ng/L ）, while plasma Pro-BNP levels in non-survivors have an increasing trend [ （4128.8±1051.1 ）, （ 5315.9 ±925.4 ） vs. （ 6899. 9± 1327.9 ） ng/L ]. There is statistical significance of plasma Pro-BNP levels at day 1,3 and 5 for the two groups （ t = 3.057,5.083, and 6. 290 respectively, P 〈 0. 01 ）. The 28-day mortality and Plasma Pro-BNP levels in cardiac dysfunction group were higher than of non- dysfunction group （ 28-day mortality ： 62. 1% vs. 20. 0% ; Pro-BNP1 ： （ 1592. 8 ±362. 2 ）ng/L vs. （4556. 6 ± 732. 7） ng/L; Pro-BNP3 ： （ 2933.6 ± 421.7 ） vs. （5768.5 ± 793.7 ） ng/L, Pro-BNP5 ： （ 3014. 5 ± 587. 5 ） ng/L vs. （8873.9 ± 1670. 1 ） ng/L （X2 = 20. 635, P = 0. 000, t = 3. 626,3. 154,3. 310, P 〈 0. O1 ]. Pro-BNP level greater than 3053 ng/L on the 5-day was an independent prognostic indicator of 28-day mortality （ sensitivity ： 88.4% ;specificity ：91.5% ）. Pro-BNP level greater than 2378 ng/L on the 5-day was an independent prognostic indicator of hospital mortality （ sensitivity： 84. 9% ; specificity： 91.8% ） . In multivariate logistic regression analyses,Pro-BNP level and APACHE score were independent predictors of 28-day mortality and hospital mortality. Conclusion Plasma Pro-BNP level shows obvious significance in evaluation of sepsis-induced myocardial depression severity in patients with septic shock. Pro-BNP level in ICU at day 5 after inclusion is an independent prognostic marker of mortality in septic shock.
出处
《中国综合临床》
2012年第12期1268-1272,共5页
Clinical Medicine of China
基金
北京市教育委员会科技发展基金（kin200710025027）
关键词
脓毒性休克
B型钠尿肽前体
预后
Septic shock
Pro-B-type natriuretic peptide
Prognosis
