降钙素原和脑钠肽与脓毒症预后关系的临床研究

Relationship between procalcitonin,brain natriuretic peptide and prognosis of sepsis: a clinical study

目的:探讨脓毒症患者降钙素原(PCT)、脑钠肽(BNP)水平变化及其与预后的关系。方法:选取2012年3月至2014年10月中山市黄圃人民医院收治的92例脓毒症患者的临床资料,根据是否伴有休克分为脓毒症组(n=49)和脓毒性休克组(n=43),检测患者入院后1、3、5 d血浆PCT、BNP水平,进行急性生理学及慢性健康评估(APACHEⅡ)评分,同时测定动脉血乳酸(Lac)、血小板(PLT)水平;另选取同期20例健康体检者作为对照组。结果:脓毒性休克组入院后1、3、5 d PCT水平和BNP水平均明显高于脓毒症组(P<0.01);脓毒症组第5天PCT、BNP水平较第3天下降(P<0.05),脓毒性休克组第3、5天PCT、BNP水平较第1天上升(P<0.05)。血浆PCT水平与BNP水平呈正相关关系(P<0.01),血浆PCT、BNP水平与Lac水平及APACHEⅡ评分呈正相关关系(P<0.05),而与PLT水平呈负相关(P<0.05)。脓毒性休克组患者28 d病死率明显高于脓毒症组患者(58.14%比45.65%,P<0.05)结论:PCT、BNP有助于预测脓毒症患者的预后,PCT、BNP水平升高提示预后不良。

Objective： To investigate the alterations in procalcitonin（ PCT） and brain natriuretic peptide（ BNP） levels in patients with sepsis and their relationship with prognosis. Methods： Between March 2012 and October 2014,92 cases of patients with sepsis treated in Huangpu People＇ s Hospital of Zhongshan city were included in the study. Depending on whether the clinical data suggested shock,the patients were divided into simple sepsis group（ n = 49） and septic shock group（ n = 43）. At 1,3 and 5 days after admission,the patients were determined for plasma PCT and BNP levels,rated with acute physiology and chronic health evaluation（ APACHE Ⅱ） scores,and examined for arterial blood lactate（ Lac） and platelet（ PLT） levels. A contemporary cohort of 20 healthy volunteers was included in the control group. Results： At 1,3 and 5 days after admission,the patients in septic shock group showed significantly higher PCT and BNP levels than those in simple sepsis group（ P0.01）. The simple sepsis group showed lowered levels of PCT and BNP on day 5 compared with the levels on day 3（ P0.05）. On days 3 and 5,the septic shock group showed increased levels of PCT and BNP compared with the levels on day 1（ P0.05）. Plasma PCT levels were positively correlated with BNP levels（ P 0. 01）.Plasma PCT and BNP levels were positively correlated with Lac levels and APACHE Ⅱ scores（ P 0. 05）,but negatively correlated with PLT levels（ P0.05）.The 28 day mortality in septic shock group was higher than that in simple sepsis group（ 58. 14% vs 45. 65%,P 0. 05） Conclusion： PCT and BNP detection help predict the prognosis of sepsis. Elevated levels of PCT and BNP may indicate a poor prognosis.