B型尿钠肽与肌钙蛋白I联合检测对严重脓毒症患者预后的临床研究

目的探讨严重脓毒症患者血肌钙蛋白I(cTnI)、B型尿钠肽(BNP)值的变化及其与预后的关系。方法检测43例严重脓毒症患者入院24h内血cTnI、BNP值,并进行急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分。按照患者的预后结局分为生存组和死亡组,比较两组cTnI、BNP值与APACHEⅡ评分的差异。用ROC曲线评价血cTnI、BNP水平变化对预后的诊断价值。结果死亡组cTnI、BNP、APACHEⅡ评分明显高于生存组,差异均有统计学意义(t分别=-6.20、-5.31、-8.88,P均<0.05);cTnI、BNP及APACHEⅡ相互之间呈正相关(r分别=0.55、0.64、0.45,P均<0.05);入院24h内血cTnI水平1.75ng/ml和血BNP水平709.50pg/ml为最佳诊断临界点。结论血cTnI与BNP联合检测可以作为一种常规临床检测指标来判断严重脓毒症患者的预后。

Evaluations on prognostic values of cTnI and BNP in patients with severe sepsis

Objective To investigate the changes of cTnI and BNP in the patients with severe sepsis and analyze their association with prognosis. Methods A total of 43 cases with severe sepsis were obtained. The plasma cTnI and BNP level were measured and APACHE Ⅱ score were collected when the patients stayed in ICU in 24 hours. The patients were divided into survival group （n=26）and death group （n=17） according to their prognosis. The plasma cTnI and BNP levels and the APACHE Ⅱ score between two groups were compared. The prognostic values of cTnI and BNP were evaluated by ROC. Results The cTnI and BNP levels and APACHE Ⅱ score of death group were significantly higher than those of survival group （t=-6.20, -5.31,-8.88,P〈0.05）, The plasma cTnI, BNP and APACHE Ⅱscore were positive related respectively （r=0.55, 0.64, 0.45, P〈0.05）.The plasma cTnI levels 1.75 ng/ml and blood BNP level 709.50 pg/ml in ICU in 24 hours were the best diagnostic critical point. Conclusions CTnI combined with BNP level could be a routine clinical biomarker to evaluate prognosis of the patients with severe sepsis.