血清N末端前体BNP及肌钙蛋白I与脓毒症关系研究

目的评价N末端前体脑钠肽及肌钙蛋白I对脓毒症预后判断的作用。方法采用回顾性研究，选取住院的脓毒症患者41例，按病情严重程度分为轻度脓毒症组（22例）及严重脓毒症组（19例），严重脓毒症组根据预后情况分为生存组（11例）及死亡组（8例），同时选取同期住院的健康体检者20例为非脓毒症对照组，在入院的24h内检测NT-proBNP、CTnI等指标，应用单因素方差分析比较各组间NT—proBNP、CTnI水平，绘制受试者工作特征曲线，并计算曲线下面积，结合专业背景知识得到最优的界值和相应的灵敏度、特异度、约登指数。在校正性别、年龄、血管活性药物应川、肌酐清除率等影响因素的条件下，应用Logistics回归方法分析NT—proBNP对严重脓毒症预后判断的价值。结果严重脓毒症组BNP及CTnI与轻度脓毒症组、非脓毒症组比较均明显升高（P〈0．01），严重脓毒症患者死亡组BNP及CTnI较生存组明显升高（P〈0．01）。NT—proBNP及CTnl的AUC分别为0．89（95％CI为0．42～0．96）、0．67（95％C1为0．61～0．88），多元Logistics回归提示在校正性别、年龄、血管活性药物使用、肌酐清除牢等影响后Nrr—proBNP最终进入回归模型（OR=2．914，P〈0．05），提示NT—proBNP为影响严重脓毒症预后的独立预测凶素，CTnl未进入回归模型。结论NT—proBNP及CTnI对脓毒症患者危险分层及预后都有较好的价值，尤其对于严重脓毒症预后的判断，NT—proBNt，优于CTnI，且NT—proBNP为严重脓毒症预后的独立预测因素。

The research of relation between serum N-terminal pro-brain natriuretic peptide and cardiac troponin I with sepsis

Objective To evaluate the prognostic value of N-terminal pro-brain natriuretic peptide and cardiac lroponin I in patients with sepsis. Methods This was a retrospective study. To choose 41 patients with sepsis in hospital, the patients were divide into mild sepsis group （22 cases） and severe sepsis group （19 cases） according to patient＇s condition, and the severe sepsis patient＇s were divide into survival group and death group according to patient＇s prognostic, meanwhile, to choose 20 health examination patients as control group. The Serum NT-proBNP and CTnI levels were determined in 24 hours after admission.One-factor analysis of variance was used to compare the NT-proBNP levels between each groups.Using receiver operating characteristic curves, we calculated the area under the curve, 95 % confidence interval, and cutoff value. Logistics regression analyses were used to evaluate the prognostic wllue of NT-proBNP in patients with severe sepsis; meanwhile, we adjusted the influence of gender, age, the use of vasopressors, and creatinine clearance. Results The NT-proBNP and CTnI levels in severe sepsis group was significant higher compare to mild sepsis group and control group （P 〈 0. 01）.And in severe sepsis cases, The NT-proBNP and CTnI levels of death group was significant higher compare to survival group（P〈 0.01）.The AUC of NT-proBNPwas0.89（95%CIis 0.42- 0.96）,and the AUC of CTnl was 0.67（95%C1 is 0.61 - 0.88）,Logistics regression analyses showed that NT-proBNP was significantly eorrelated with the prognosis of severe sepsis （OR = 2.914 , P 〈 0.05）, and the prognostic value of NT-proBNP was not affected by the gender, age, the use of vasopressors, and creatinine clearance. It indicated that NT-proBNP was a independent predictor for the prognosis of severe sepsis.But the CTnI was not significantly correlated with the prognosis of severe sepsis. Conclusion Determination of NT-proBNP and CTnI has a hetter prognostic value and risk classity for the patients with sepsis, especially to evaluate the prognosis of severe sepsis, NT-proBNP was better than CTnl, and NT-proBNP was a independent predictor for the prognosis of severe sepsis.