NT-proBNP对脓毒症患者的预后评估

目的评价N端B型脑钠肽前体(NT-proBNP)对脓毒症患者预后评估的临床价值。方法选取2011年1月—2013年6月我院重症医学科收治的60例脓毒症,按患者入院28 d后的生存情况分为生存组42例和死亡组18例,比较两组入院2 h内NT-proBNP水平及入院24 h内急性生理学与慢性健康状态评价系统Ⅱ(acute physiology and chronichealth evaluation,APACHEⅡ)评分,通过建立受试者工作特征(ROC)曲线探讨NT-proBNP对脓毒症患者预后评估的价值。结果入院2 h内,死亡组NT-proBNP水平为(5873.24±1768.37)pg/ml明显高于生存组的(2170.45±625.28)pg/ml,差异有统计学意义(t=2.660,P=0.015);死亡组APACHEⅡ评分为(26.47±5.32)分,也明显高于生存组的(21.54±4.35)分,差异有统计学意义(t=2.390,P=0.020)。Pearson相关性分析显示,NT-proBNP与APACHEⅡ评分呈正相关(r=0.509,P=0.003)。NT-proBNP水平和APACHEⅡ评分的ROC曲线下面积分别为0.730和0.715,两者评估预后效能相仿。结论 NT-proBNP对脓毒症患者预后评估有较好的临床价值,可作为脓毒症患者预后判断的一个参考指标。

Clinical Value of NT-proBNP on the Prognosis of Patients with Sepsis

Objective To evaluate the prognosis value of immunoreactive amino-terminal pro-brain natriuretic peptide （NT-proBNP） on patients with sepsis. Methods A total of 60 sepsis patients admitted during January 2011 and June 2013 were divided into survival group （n = 42） and death group （n = 18） based on the survival status on the 28th d after admission. Serum NT-proBNP levels within 2 h after admission and APACHE II （acute physiology and chronic health evaluation II） scores within 24 h after admission in the two groups were compared, and the value of NT-proBNP on prognostic assessment of sepsis patients were investigated by establishment of the ROC curve of work characteristics. Results The serum level of NT-proBNP in death group （5873. 24 ± 1768. 37）pg/ ml was significant higher than （2170. 45 ± 625. 28） pg/ ml in the survival group, and the difference was statistically significant （t = 2. 660, P = 0. 015）; APECHE II score of （26. 47 ± 5. 32） in death group was significantly higher than （21. 54 ± 4. 35）in survival group, and the difference was also statistically significant （t =2. 390, P = 0. 020）. Pearson correlation analysis indicated that the serum NT-proBNP level had a positive correlation with APACHE II score （r = 0. 509, P = 0. 003）. The area under the ROC curve for NT-proBNP level and APACHE II score were 0. 730 and 0. 715 respectively, which had a similar prognosis assessment value in sepsis patients. Conclusion NT-proBNP has a better clinical value on the prognosis assessment of sepsis patients, and can be served as a reference index for the prog-nosis evaluation in sepsis patients.