脓毒症患者早期血清降钙素原、C反应蛋白及脑利钠肽水平对预后的评估价值

Clinical value of early serum procalcitonin, C-reactive protein and brain natriuretic peptide on prognosis of patients with sepsis

目的探讨脓毒症患者早期血清降钙素原（PCT）、C反应蛋白（CRP）和脑利钠肽（BNP）水平对其预后的影响。方法回顾性分析解放军总医院外科重症监护病房2011年1月-2014年1月收治的45例脓毒症患者的临床资料,按预后分为存活组（n=36）和死亡组（n=9）,分析两组患者血清PCT、CRP和BNP水平在入院第1天的差异及与APACHEⅡ评分的相关性,并以受试者工作曲线（ROC）分析各参数对脓毒症患者预后的判断价值。结果入院第1天,两组患者血清BNP水平和APACHEⅡ评分即存在显著性差异（P〈0.05）,且BNP水平与APACHEⅡ评分显著相关（r=0.3062,P=0.0408）。两组患者PCT与CRP水平均无明显差异（P〉0.05）,与APACHEⅡ评分亦无显著相关（P〉0.05）。ROC曲线分析表明,BNP对脓毒症预后判断价值有统计学意义（P=0.002,AUC=0.775,95%CI 0.626-0.886）。结论血清BNP水平可作为脓毒症患者转归的早期预测指标。

Objective To explore clinical value of early serum procalcitonin （PCT）, C-reactive protein （CRP） and brain natriuretic peptide （BNP） on the prognosis of patients with sepsis. Methods The data of 45 ICU patients with sepsis in General Hospital of PLA admitted from Jan. 2011 to Jan. 2014 were retrospectively analyzed, and they were divided into survival group （n=36） and death group （n=9）. The difference between serum PCT, CRP and BNP levels on the first day of their admission between the two groups was compared, and the relationship between the PCT, CRP, BNP levels and APACHE Ⅱ scores was also analyzed. Finally the positive predictive value of these biomarkers was assessed by using ROC curve. Results Significant differences were found in the serum BNP level and APACHE Ⅱ score between the two groups on the first day of their admission （P〈0.05）, and a significant correlation was also found between the serum BNP level and APACHE Ⅱ score （r=0.3062, P=0.0408）. However, no significant difference was found in serum PCT and CRP levels between the two groups （P〉0.05）, also the serum PCT and CRP levels showed no significant correlation with the APACHE Ⅱscore （P〉0.05）. Analysis of ROC curve showed that the sensitivity and specificity of serum BNP level showed a statistically significant predictive value in prognosis of sepsis （P=0.002, AUC=0.775, 95%CI： 0.626- 0.886）. Conclusion The serum BNP level may be used as a critical parameter in predicting the prognosis of sepsis.