降钙素原与超敏C-反应蛋白和N末端前体脑钠肽对脓毒症预后的评估价值

Value of procalcitonin,high-sensitivity C-reactive protein,and N-terminal pro-brain natriuretic peptide in assessment of prognosis of sepsis

目的探讨血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和N末端前体脑钠肽(NT-proBNP)对脓毒血症预后评估的价值,为临床诊断、治疗提供参考。方法选取医院2012年1月-2015年1月入住ICU的脓毒血症患者81例为研究对象,按照预后情况将患者分为死亡组35例和存活组46例,比较两组患者发病早期PCT、hs-CRP、NT-proBNP及急性生理与慢性健康状况(APACHEⅡ)评分,并通过ROC曲线观察3种指标对预后评估的参考价值;采用SPSS20.0软件进行统计分析。结果两组患者PCT、hs-CRP、NT-proBNP和APACHEⅡ评分差异均有统计学意义(P<0.05),同时PCT、hs-CRP、NT-proBNP指标水平与APACHEⅡ评分存在明显相关(P<0.05);PCT、hs-CRP、NT-proBNP和APACHEⅡ评分预测死亡的受试者工作特征曲线(ROC)下面积分别为0.812、0.543、0.856和0.858,PCT的敏感性和特异性为79.5%和77.4%,hs-CRP的敏感性和特异性为69.3%和70.0%,NT-proBNP敏感性和特异性为80.1%和83.3%,APACHEⅡ评分敏感性和特异性为96.1%和80.5%,APACHEⅡ评分诊断价值最高,PCT和NT-proBNP对脓毒血症预后的评估优于hs-CRP。结论 NT-proBNP和PCT对脓毒血症患者具有较高的预后评估价值,准确的判断脓毒症患者的预后,可以降低脓毒血症患者的病死率。

OBJECTIVE To explore the value of serum procalcitonin（PCT）,high-sensitivity C-reactive protein（hsCRP）,and N-terminal pro-brain natriuretic peptide（NT-proBNP）in assessment of prognosis of sepsis so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 81 sepsis patients who were hospitalized the ICU from Jan 2012 to Jan 2015 were recruited as the study objects and divided into the death group with35 cases and the survival group with 46 cases according to the prognosis of the patients.The levels of PCT,hsCRP,and NT-proBNP as well as the acute physiology and chronic health evaluation（APACHE Ⅱ）score were compared between the two groups of patients in early stage of onset of diseases,the reference value of the three indicators in assessment of prognosis was observed by means of ROC curve,and the statistical analysis was performed with the use of SPSS20.0software.RESULTS There was significant difference in the level of PCT,hsCRP,or NT-proBNP or APACHEⅡscore between the two groups of patients（P〈0.05）.The levels of PCT,hsCRP,and NT-proBNP were remarkably associated with the APACHEⅡscore（P〈0.05）.The area under receiver-operating-characteristic（ROC）curve of the PCT,hs-CRP,NT-proBNP,and APACHEⅡ score in the prediction of death were 0.812,0.543,0.856,and 0.858,repectively.The sensitivity of the PCT was 79.5%,the hsCRP 69.3%,the NT-proBNP 80.1%,the APACHEⅡscore 96.1%;the specificity of the PCT was 77.4%,the hs-CRP 70%,the NT-proBNP 83.3%,the APACHEⅡ score 80.5%;the diagnostic value of the APACHEⅡscore was the highest;the PCT and NT-proBNP were superior to the hs-CRP.CONCLUSION The PCT and NTproBNP have great value in assessment of prognosis of the sepsis patients,accurately determine the prognosis of the sepsis patients,and reduce the mortality rate of the sepsis patients.