脓毒症患者血清肌钙蛋白I和B型脑钠肽与预后的相关性分析

Correlation between levels of serum troponin I or B-type natriuretic peptide and prognosis in patients with sepsis

目的：探讨脓毒症患者血清肌钙蛋白I（troponin I，cTnI）和B型脑钠肽（b-type natriuretic peptide，BNP）水平与预后的关系。方法纳入2010年1月~2012年9月在北京安贞医院急诊抢救室及重症监护病房住院脓毒症患者48例，非脓毒症患者52例。以就诊时cTnI和BNP水平和入院24 h的急性生理功能和慢性健康状况评分系统（APACHE Ⅱ）评分作为基线资料。通过Cox比例风险回归法分析cTnI和BNP与预后关系，预后不良指标包括院内和出院30 d内死亡及APACHE评分≥20分。结果脓毒症组与非脓毒症组的性别、年龄和原发病构成比、APACHE Ⅱ评分等差异无统计学意义（P＞0.05）。脓毒症组中有47.92%（23/48）存在cTnI和（或）BNP水平升高，非脓毒症组中有28.84%（15/52）存在cTnI和（或） BNP水平升高，两组差异有统计学意义（P＜0.05）。生存分析结果显示，脓毒症患者的预后不良与cTnI、BNP增高有关。结论血清cTnI、BNP水平升高有助于判断脓毒症患者的预后。

Objective To discuss the relationship between the levels of serum troponin I （cTnI） or B-type natriuretic peptide （BNP） and prognosis in patients with sepsis.Methods The patients （n=100） hospitalized in emergency room and ICU of the Beijing Anzhen Hospital were chosen from Jan. 2010 to Sept. 2012, and among them 48 with sepsis （sepsis group） and 52 without sepsis （non-sepsis group）. The levels of cTnI and BNP at the time of visiting hospital and scores of APACHE Ⅱ after hospitalized for 24 h were taken as baseline data. The relationship between cTnI or BNP and prognosis was analyzed by using Cox proportional hazard regression methods. The indexes of poor prognosis included the mortality in hospital, mortality within 30 days after discharged and scores of APACHEⅡ≥20.Results The differences in sex, age, ratio of protopathy and scores of APACHE Ⅱ had no statistical significance between two groups （P〉0.05）. There were 47.92% （23/48） cases had higher levels of cTnI and （or） BNP in sepsis group, and 28.84% （15/52） cases in non-sepsis group （P〈0.05）. The results of survival analysis showed that the poor prognosis was related to the increase of levels of cTnI and BNP.Conclusion The increase of levels of cTnI and BNP can be taken as a reference for estimating the prognosis in the patients with sepsis.