前心房利钠肽浓度测定对脓毒症早期诊断的临床价值研究

The clinical value of Pro-atrial natriuretic peptide in sepsis early specifical diagnosis

目的探讨前心房利钠肽(pro-ANP)在脓毒症早期特异性诊断中的临床价值。方法前瞻性地将2007年6月至11月上海交通大学附属第一人民医院综合重症加强治疗病房(ICU)51例危重病患者按国际脓毒症标准分为全身性炎症反应综合征(SIRS,25例)、脓毒症(12例)、严重脓毒症(9例)、脓毒症性休克(5例)4组,53名年龄相匹配的健康个体作为对照组,采用新型夹心免疫荧光法检测各组患者中血pro-ANP浓度并和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、降钙素原(PCT)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)等比较。结果SIRS组、脓毒症、严重脓毒症和脓毒症性休克组,血浆pro-ANP浓度逐渐升高(分别为87.22、533.30、1098.73和1933.94μg/L),差异有统计学意义(P<0.05)。在脓毒症组中,与其他标志物相比,死亡患者的pro-ANP浓度比存活患者明显升高,差异有统计学意义(P<0.05),在住院第1天差异即非常明显(P<0.05)。在脓毒症患者的受试者工作曲线分析中,pro-ANP和PCT、APACHEⅡ评分的曲线下面积相同,明显高于CRP和IL-6。结论pro-ANP浓度测定对脓毒症早期特异性诊断和严重程度评估有极大的临床价值。

Objective To evaluate the clinical value of pro-atrial natriuretic peptide（pro-ANP） in early specifical diagnosis of sepsis. Methods We performed prospective trial. According to the international sepsis＇ criteria,51 critically ill patients admitted to the intensive care unit were classified into four groups：systemic inflammatory response syndrome （ SIRS,25 ）, sepsis （ 12 ）, severe sepsis （ 9 ） and septic shock （ 5 ）, with 53 age-matched healthy individuals as control groups. The level of plasma pro-ANP was measured in each group, and compared with the other biomarkers（ i. e. procalcitonin, C-reactive protein and IL-6）and the Acute Physiology and Chronic Health Evaluation（APACHE） Ⅱ scorewas obtained, pro-ANP was detected using a new sandwich immunoassay. Results Median pro-ANP concentration was 87. 22μg/L for SIRS ,533. 30 for sepsis, 1098. 73 for severe sepsis and 1933.94 for septic shock, the plasma concentration of pro-ANP exhibited a gradual increase, and the median pro-ANP value was greatest in the septic shock group. Comparing with the other biomarkers, in the sepsis, severe sepsis and septic shock groups, the plasma concentration of pro-ANP in the nonsurvivors was significantly greater than in the survivors（ P 〈 0. 05 ）, and the difference in pro-ANP values was clear on the first day of admission to the ICU （P 〈 0. 05 ）. By the receiver operating characteristic （ROC）plot analysis of pro-ANP in sepsis patients, the area under the ROC curve for pro-ANP was similar to the area under the ROC curve for PCT and A- PACHE Ⅱ score,and was significantly higher than the area under the ROC curve for CRP and IL-6. Conclusion The measurement of pro-ANP has great clinical value in the early specifical diagnosis and risk assessment in sepsis.