脓毒症患者血浆N-末端脑钠肽前体与肾功能的变化及其临床意义

目的探讨严重脓毒症和脓毒症休克患者血浆N-末端脑钠肽前体(NT-ProBNP)的变化及其与肾小球滤过率(eGFR)的关系及临床意义。方法纳入严重脓毒症患者41例和脓毒症休克患者10例。统计患者年龄、性别、主要感染部位、APACHEⅡ评分以及住院病死率,检测患者入院后24 h内血浆NT-ProB-NP及肌酐水平,并计算eGFR。按预后分为存活组(28例)和死亡组(23例),比较两组患者APACHEⅡ评分及NT-ProBNP、eGFR的变化及相关性,并以eGFR为协变量,比较两组NT-ProBNP的变化。结果严重脓毒症和脓毒症休克患者合计病死率为45.1%(23/51)。死亡组APACHEⅡ评分、NT-ProBNP和eGFR与存活组比较有差异(P<0.05)。NT-ProBNP与eGFR呈负相关,协方差分析表明死亡组NT-ProBNP水平仍高于存活组(P<0.05)。结论严重脓毒症及脓毒症休克患者肾功能的损伤及RT-ProBNP的改变均与病变严重程度密切相关,NT-ProBNP水平与脓毒症患者的预后有关。

The relationship of plasma NT - proBNP and eGFR measurement and their value in prognosis of patientswith severe sepsis and septic shock

Objective To investigate the change of plasma N-terminal pro-brain natriuretic peptide （NT- ProBNP） and estimated glomerular filtration rate （eGFR） in the patient with severe sepsis and septic shock syndrome, and explore their relationship and clinical significance. Methods Fifty one patients with sepsis were enrolled, severe sepsis （41 cases） and septic shock （10 cases）. Age,sex,primary site of infection,APACHE Ⅱ score and hospital mor- tality were counted. The plasma NT-ProBNP and creatinine level were measured 24 h after patients in admission, then the eGFR level were calculated according to the creatinine level. The cases were divided into survival group （28 cases） and death group （23cases） on the basis of prognosis. In the two groups, the associations between APACHE Ⅱ score, eG- FR and NT-proBNP were evaluated. Results The total mortality was 45.1% （23/51）. In the death group the APACHE llscore, NT-ProBNP and eGFR were higher than those in the survival group （P 〈 0. 05 ）. NT-ProBNP and eGFR were negatively correlated. Covarianee analysis result showed that death group NT-ProBNP was still higher than that of surviv- al group （ P 〈 0.05）. Conclusion Both the function of kidney and the level of NT-ProBNP are closely related with the prognosis in severe sepsis and septic shock patients, NT-proBNP concentration is related with the prognosis.