血浆脑钠肽与脓毒症患者相关性分析及其对早期预后的影响

Plasma brain natriuretic peptide (BNP) levels in patients with sepsis and analysis of brain natriuretic peptide on early prognosis

目的探讨血浆脑钠肽(BNP)水平变化对脓毒症患者病情严重情况相关性及临床意义,并分析脑钠肽水平对早期预后的影响。方法随机入选2011年1月至2013年7月我院重症医学科(ICU)135例脓毒症患者,分为脓毒症组50例,严重脓毒症组46例,脓毒性休克组39例,并选择同期门诊健康体检者50例为对照组。于入院确诊后第1天行脑钠肽、超声心动图、血乳酸等检查,行APACHEⅡ评分评估,并于4周后观察各组死亡率。分析4组患者血浆BNP水平、乳酸、左室射血分数(LVEF)及APACHEⅡ评分的变化,并比较各组死亡率变化进行亚组分析。结果①各组脑钠肽水平均较对照组高,有统计学差异(均P<0.05),脓毒症休克组脑钠肽水平、APACHEⅡ评分较严重脓毒症组及脓毒症组高,严重脓毒症组较脓毒症组高,有统计学差异(均P<0.05);脓毒症休克组LVEF较严重脓毒症组及脓毒症组低,且乳酸水平较其他2组增高(均P<0.05),但严重脓毒症组与脓毒症组LVEF、乳酸水平无明显统计学差异(P>0.05)。②Pearson相关进行线性相关性分析后脓毒症休克组脑钠肽与LVEF、乳酸呈正相关,与APACHEⅡ呈负相关(均P<0.05);严重脓毒症组脑钠肽与LVEF呈相关,与APACHEⅡ呈负相关(均P<0.05);脓毒症组脑钠肽与APACHEⅡ呈负相关(P<0.05)。③4周内患者死亡率以脓毒症休克组患者最高(P<0.05),而脓毒症组与严重脓毒症比较无明显统计学差异(P>0.05)。亚组分析表明死亡组脑钠肽、LVEF、APACHEⅡ评分、乳酸均较存活组高(均P<0.05),但经多因素Logistic回归分析后显示BNP水平升高、APACHEⅡ评分增高、乳酸增高均是脓毒症患者死亡的独立危险因素(OR=1.210、1.107、1.098,均P<0.05)。结论脓毒症患者血浆BNP水平显著升高,且与病情轻重、左心室收缩功能、早期预后有关,BNP水平的检测可以作为脓毒症患者的病情严重程度以及早期预后的指标。

Objective To investigate plasma brain natriuretic peptide （BNP） levels in patients with sepsis and analysis of brain natriuretic peptide on early prognosis. Methods Randomly selected from January 2011 to July 2013 in our hospital ICU ward with 135 cases of sepsis patients were divided into group of 50 cases of sepsis group, 46 cases of severe sepsis group, 39 cases of septic shock group, and selected 50 cases in the corresponding period Outpatient as the control group. We detected brain natriuretic pep- tide, echocardiography, blood lactate and other tests in the first day, and APACHE I1 score evaluated at 4 weeks. Analysis of plasma BNP levels in patients,lactic acid,left ventricular ejection fraction （LVEF） and APACHE lI score changes, and subgroup analysis were performed. Results （~）Brain natriuretic peptide levels in each group compared with significant difference the control group（P 〈 O. 05 ）, brain natriuretic peptide levels, APACHE I1 score in septic shock group were higher than the severe sepsis group and sep- sis group,severe sepsis group was significant difference compared with sepsis group（ P 〈 0. 05 ） ; LVEF of septic shock group com- pared with severe sepsis and septic group was lower, and lactate levels was higher than the other two group（ P 〈 0. 05 ）, but LVEF, lactate levels in severe sepsis group and sepsis group was no significant difference （P 〉 0. 05）. （~Brain natfiuretic peptide was posi- tively correlated with LVEF,lactic acid and APACHE ]I was negatively in septic shock group with pearson correlation analysis （P 〈 0. 05 ） ; brain natriuretic peptide of severe sepsis group were correlated with LVEF, and negatively correlated with APACHE II （ P 〈 O. 05 ） ;brain natriuretic peptide of sepsis group and APACHE 11 were negative correlation（ P 〈 O. 05 ）. （~）Four weeks of mortality in patients with septic shock group were highest（P 〈0. 05 ） ,severe sepsis and sepsis group compared with no significant difference（ P 〉 0. 05 ）. Subgroup analysis showed that BNP, LVEF, APACHE 1I score,lactic acid of the death group were higher than the survival group （ P 〈 0. 05 ）, but after multivariate Logistic regression analysis showed elevated BNP levels, higher APACHE I1 score, increased lactic acid levels were independent risk factors in death （ OR = 1. 210,1. 107,1. 098,P 〈 0. 05 ）. Conclusion Plasma BNP levels in patients with sepsis was significantly higher, and with the left ventricular systolic function, early prognosis, BNP levels could be used as the detection of disease severity in patients with sepsis and evaluated early prognosis.