老年脓毒性休克患者血浆脑钠肽水平的临床意义

目的动态监测老年脓毒性休克患者血浆脑钠肽(BNP)水平以及血清降钙素原(PCT)、单核细胞人白细胞抗原-DR(HLA-DR)、APACHEⅢ评分的变化,并评价其临床意义。方法检测62例老年脓毒性休克患者复苏治疗前及治疗后1周的血浆BNP水平,同时测PCT、HLA-DR及APACHEⅢ评分。结果复苏治疗1周后,8例复苏成功患者(复苏成功组)血浆BNP、PCT水平及APACHEⅢ评分呈明显下降趋势,HLA-DR呈明显上升趋势(均P0.05);42例复苏后病情无好转或加重者(复苏不成功组)血浆BNP、PCT水平及APACHEⅢ评分呈持续或进行性上升趋势,HLA-DR呈明显下降趋势(均P0.05);复苏1周,12例死亡(死亡组),其中3例死亡当天BNP水平高达4000 ng/L以上,7例达3000 ng/L以上;3组患者复苏前血浆BNP水平、APACHEⅢ评分有显著差异(P0.05),PCT、HLA-DR无显著差异(P0.05)。结论老年脓毒性休克患者血浆BNP水平越高,预后越差;血浆BNP水平可作为评价老年脓毒性休克疗效与预后的重要指标。

Clinical significance of plasma brain natriuretic peptides in elderly patients with septic shock

Objective To monitor the changes in plasma levels of brain natriuretic peptides（BNP）,procalcitonin（PCT）,monocyte human leukocyte antigen DR（HLA-DR） and acute physiology and chronic health evaluation（APACHE） Ⅲ score in elderly patients with septic shock,and to evaluate the clinical significance.Methods The above indices were measured before and at one week after resuscitation in 62 elderly patients with septic shock.Results At one week after resuscitation,the plasma levels of BNP,PCT,and APACHE Ⅲ score showed a significant decreasing tendency,and the expression of HLA-DR a significant increasing tendency in 8 patients（resuscitation successful group）（P0.05）.The plasma levels of BNP,PCT,and APACHE Ⅲ score showed a significant increasing tendency,and the expression of HLA-DR a significant decreasing tendency in 42 patients（resuscitation failure group）.Twelve patients died（death group）;among them,the level of plasma BNP reached more than 4000 ng/L in 3 patients and more than 3000 ng/L in 7 patients on the day of death.There was significant difference in plasma BNP level and APACHE Ⅲ score（P0.05）,and no difference in PCT and HLA-DR（P0.05）among the 3 groups.Conclusion In elderly patients with septic shock,the higher plasma BNP level predicates poorer prognosis.Plasma BNP level might be an strong predicator for treatment effciency evaluation and prognosis of septic shock in the elderly patients.