NT-proBNP、CRP、PCT对脓毒症及脓毒症休克患者病情及预后的评估价值

Value of NT-proBNP,CRP and PCT in the Evaluation of the Condition and Prognosis of Patients with Sepsis and Septic Shock

目的探讨脓毒症及脓毒症休克患者氨基末端脑钠肽前体、C反应蛋白、降钙素原表达意义及其对预后的预测价值。方法选取2017年4月1日-2019年7月31日某院收治的87例脓毒症患者作为脓毒症组,选取同期71例脓毒症休克患者作为SS组,比较两组血清氨基末端脑钠肽前体、C反应蛋白、降钙素原水平及急性生理与慢性健康评分、序惯器官功能衰竭估计评分,采用Pearson分析各指标与急性生理与慢性健康评分、序惯器官功能衰竭估计评分相关性,采用受试者工作特征曲线分析各指标对预后的预测价值。结果SS组血清氨基末端脑钠肽前体、C反应蛋白、降钙素原水平及急性生理与慢性健康评分、序惯器官功能衰竭估计评分分别为(944.91±131.55)pg/ml、(128.76±60.33)mg/L、(13.75±6.24)μg/L、(31.57±8.26)分、(8.71±1.05)分,较脓毒症组的(561.88±110.74)pg/ml、(69.73±31.08)mg/L、(9.16±5.29)μg/L、(23.03±6.44)分、(5.96±0.87)分高(P<0.05);血清氨基末端脑钠肽前体、C反应蛋白、降钙素原水平与急性生理与慢性健康评分(r=0.723、0.611、0.625)、序惯器官功能衰竭估计评分(r=0.631、0.514、0.565)均呈正相关(P<0.05);预测病死的AUC NT-proBNP(0.797)>PCT(0.690)>CRP(0.632)(P<0.05);NT-proBNP、CRP、PCT高危、低危者生存曲线相比,差异有统计学意义(P<0.05)。结论脓毒症及脓毒症休克患者氨基末端脑钠肽前体、C反应蛋白、降钙素原呈高表达,与病情呈正相关,且氨基末端脑钠肽前体预测预后的价值最高。

Objective To explore the expression significance of amino-terminal brain natriuretic peptide precursor,C-reactive protein,and procalcitonin in patients with sepsis and septic shock and its predictive value for prognosis.Methods 87 patients with sepsis admitted to a hospital from April 1,2017 to July 31,2019 were selected as sepsis group and 71 patients with septic shock were selected as the SS group during the same period,the serum amino-terminal brain natriuretic peptide precursors,C-reactive protein,procalcitonin levels,acute physiological and chronic health scores,and sequential organ failure estimation scores between the two groups,were compared,Pearson analysis was used to correlate the indicators with acute physiological and chronic health scores,and sequential organ failure estimation scores,the predictive value of each index on the prognosis was analyzed using the receiver operating characteristic curve.Results Serum amino-terminal brain natriuretic peptide precursor,C-reactive protein,procalcitonin levels,acute physiological and chronic health scores,and sequential organ failure scores in SS group(944.91±131.55) pg/ml,(128.76±60.33) mg/L,(13.75±6.24) μg/L,(31.57±8.26)points,(8.71±1.05) points were higher than that in sepsis group(561.88±110.74) pg/ml,(69.73±31.08)mg/L,(9.16±5.29) μg/L,(23.03±6.44) and(5.96±0.87)(P<0.05);the levels of amino-terminal brain natriuretic peptide precursors,C-reactive protein and procalcitonin were positively correlated with the scores of acute physiology and chronic health(r=0.723,0.611,0.625) and sequential organ failure(r=0.631,0.514,0.565)(P<0.05);AUC NT-proBNP for predicting death(0.797)> PCT(0.690)> CRP(0.632)(P<0.05);compared with the survival curves of NT-proBNP,CRP,and PCT at high and low risk patients,the differences were significant(P<0.05).Conclusion The amino-terminal brain natriuretic peptide precursor,C-reactive protein,and procalcitonin are highly expressed in patients with sepsis and septic shock,which are positively correlated with the condition,and the amino-terminal brain natriuretic peptide precursor has the highest prognostic value.