血浆脑钠肽对重度脓毒症患者诊断及预后的影响

目的评价血浆脑钠肽（BNP）水平在预测重度脓毒症患者死亡及诊断中的价值。方法重度脓毒症患者41例,非脓毒组（对照组）20例,比较2组BNP水平的变化。根据脓毒症患者是否于28 d内存活将其分为存活组和死亡组,比较患者入院第1天反应蛋白、危重病评分（APACHEⅡ和SOFA）、血浆BNP水平和第3天血浆BNP水平差异。结果脓毒症组患者入院第1d和第3d血浆BNP水平明显高于对照组;死亡组重度脓毒症患者第1天和第3天血浆BNP水平与存活组相比均明显增高;logistic回归分析发现,在年龄、APACHEⅡ、SOFA、CRP及第1天和第3天BNP水平诸因素中,第3天的BNP水平和SOFA评分为预测ICU死亡的独立危险因素。结论绝大多数老年重度脓毒症患者的血浆BNP水平明显升高,BNP可成为预测老年重度脓毒症患者预后和诊断的实验室指标。

Effects of plasma brain natriuretic peptide on diagnosisi and prognosis of patients with severe sepsis

Objective To evaluate the predictive value of brain natriuretic peptide（BNP） on mortality in patient with severe sepsis.Methods Forty-one cases of severe sepsis（sepsis group） and 20 cases of non-sepsis（control group） were enrolled.The changes of BNP levels in two groups were compared.The sepsis group was divided into survival and non-survival group according to whether they survived within 28 days staying in ICU.The differences in plasma BNP level,serum C-creative protein（CRP）,APACHE Ⅱ and Sequential Organ Failure Assessment（SOFA） score between the two groups were compared on the admission day and the 3rd day.Results Plasma BNP levels of the sepsis group on the admission day and the 3rd day were significantly higher than those of the control group.BNP levels of the non-survival group on both the admission day and the 3rd day were significantly higher than those of the survival group by logistic regression analysis.BNP level on the 3rd day and SOFA score on the admission day were independent predictors of ICU mortality.Conclusion Plasma BNP increases in most patients with severe sepsis or septic shock,which may serve as index for prognosis in severe septic patients.