B型利钠肽对严重感染及感染性休克患者的心脏功能及预后的预测作用

The predictive values of B-type natriuretic peptide for the heart function and prognosis in patients with severe sepsis and septic shock

目的:观察B型利钠肽(BNP)对严重感染及感染性休克患者心脏功能的评价及其预测预后的作用。方法:前瞻性观察并收集54例严重感染及感染性休克患者入重症加强治疗病房(ICU)24h时的血浆BNP水平、左心室射血分数(LVEF)及28d病死率,用ROC曲线评价血浆BNP水平变化对死亡的预测作用,进一步将存活的患者分为BNP升高组和正常组,比较各观察指标的差异。结果:血浆BNP水平在心功能不全的患者(LVEF<50%)中要显著高于心功能正常患者(LVEF≥50%)[(1268.3±601.5)pg/mL比(764.6±297.4)pg/mL,P=0.009]。血浆BNP水平在死亡组中要明显高于存活组[(1574.1±541.4)pg/mL比(365.2±94.7)pg/mL,P=0.006],以入ICU后首个24h时血浆BNP水平>692.5pg/mL作为预测死亡的临界点,其敏感度为90.0%、特异度为82.4%。在存活的患者中,BNP升高组的ICU住院天数为(22.7±7.8)d,要明显高于正常组(14.0±5.7)d(P=0.02)。结论:血浆BNP水平可以预测严重感染及感染性休克患者的心脏功能及预后。

Objective To evaluate the prognosis predictive value of B-type natriuretic peptide （BNP） for heart function and outcome in severe sepsis and septic shock patients. Methods Fifty-four severe sepsis and septic shock patients were studied prospectively. Plasma BNP level and left ventricular ejection fraction （LVEF） were measured when the patients stayed in the intensive care unit （ICU） for 24 hours. The data from clinical feature, 28-day mortality, APACHE Ⅱ score and 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 BNP levels were significantly higher in heart dysfunction patieuts（LVEF〈50%）than those in heart function normal patients（LVEF≥50%） [（1 268.3±601.5） pg/mL vs （764.6±297.4） pg/mL,P=0.009] ;BNP levels were significantly higher in non-survivors compared with survivors[（1 574.1±541.4）pg/mL vs （365.2±94.7） pg/mL, P=0.006]. BNP greater than 692.5 pg/mL within the first 24 hours was an independent prognostic indicator of mortality （sensitivity 90.0%, specificity 82.4%）. In survival patients, the length of stay in ICU was significantly higher in BNP elevated group than that in BNP normal group [（22.7±7.8）days vs （14.0±5.7）days, P=0.02]. Conclusions Plasma BNP level could be used as a reliable marker for identification of patients developing sepsis-induced myocardial depression. Plasma BNP level is a valuable prognostic predictive factor for severe sepsis and septic shock patient.