B型利钠肽对严重感染及感染性休克患者预后的预测作用

目的 评价B型利钠肽(BNP)对严重感染及感染性休克预后的预测作用.方法 观察102例严重感染及感染性休克患者入重症监护病房(ICU)24 h血浆BNP水平、临床及预后相关资料.将患者分为28 d死亡组和存活组,比较其差异性,并用受试者工作特征曲线(ROC曲线)评价BNP水平对死亡的预测作用;进一步将存活患者分为BNP升高组和正常组,比较其差异性.结果 死亡组(39例)患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分显著高于存活组[63例,(28.9±5.9)分比(20.2±5.4)分,P<0.013,但两组白细胞计数、血乳酸值则差异无统计学意义.死亡组患者血浆BNP水平[(1 451.3±531.7)ng/L]明显高于存活组((394.55±81.7)ng/L,P<0.01);以血浆BNP水平>681.4 ng/L作为预测死亡的界点,敏感度为91.4%,特异性为80.3%.在存活组患者中,BNP升高组(48例)的ICU住院天数[(23.75±7.5)d]明显长于正常组(15例,(14.9±5.1)d,P<0.053;但两组APACHE 评分则差异无统计学意义.结论 血浆BNP水平可以预测严重感染及感染性休克的预后.

Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock

Objective To evaluate the value of B-type natriuretic peptide(BNP)in predicting the outcome of severe sepsis and septic shock patients.Methods One hundred and two patients with severe sepsis and septic shock were prospectively observed.Plasma BNP level was measured at 24th hour after admission to intensive care unit(ICU)of a university hospital.The data of clinical features,28-day mortality,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores and the length of stay (LOS)in ICU were collected.The patients were divided into survival group and non-survival group.The survival group was further divided into BNP elevated group and BNP normal group.Results APACHEⅡ scores were significantly higher in non-survivors(39 patients)compared with survivors(63 patients,28.95± 5.9vs.20.2±5.4,P<0.01),but there were no statistical difference of white blood cell count and blood lactic levels between two groups.BNP levels were significantly higher in non-survivors compared with survivors[(1 451.3±531.7)ng/L vs.(394.5±81.7)ng/L,P<0.01];BNP greater than 681.4 ng/L at first 24th hour was an independent indicator of mortality(sensitivity 91.4%,specificity 80.3%).In survivals,the LOS in ICU was significantly higher in BNP elevated group(48 patients)than BNP normal group C15 patients,(23.7±7.5)days vs.(14.95±5.1)days,P<0.05),but APACHE Ⅱ scores showed no statistical difference between two groups.Conclusion Plasma BNP level is a valuable prognostic factor for severe sepsis and septic shock patients.