降钙素原、N前端脑钠肽、乳酸对评估ICU脓毒症患者预后价值的研究

Prognostic value of procalcitonin,N-terminal precursor natriuretic peptide and lactic acid in sepsis patients of the Department of Critical Care Medicine

目的探讨ICU脓毒症患者血浆降钙素原(PCT)、N前端脑钠肽(NT-pro-BNP)、乳酸(LAC)变化的临床意义及对预后评估的价值.方法对2017年6月至2019年6月江苏大学附属金坛医院重症医学科(ICU)收治的脓毒症患者70例(观察组)和30例同期到院进行健康体检者(对照组)为研究对象进行前瞻性分析.脓毒症患者在初入ICU时抽取静脉血测定其PCT、NT-pro-BNP、LAC,对照组抽取空腹静脉血测定其PCT、NT-pro-BNP、LAC,比较上述两组指标的差异.观察组依据转归分为生存组、死亡组;比较不同转归患者PCT、NT-pro-BNP、LAC的差异.采用Spearman检验作生存死亡转归患者的PCT、NT-pro-BNP、LAC的相关性分析.应用ROC曲线评价PCT、NT-pro-BNP、LAC对脓毒症患者预后评估的价值.结果观察组患者的PCT、NT-pro-BNP、LAC分别为(23.00±27.60)ng/L、(7665.50±8084.83)ng/L、(4.59±3.47)mg/L,较对照组增高,P均<0.05.死亡组患者的PCT、NT-pro-BNP、LAC分别为(45.65±30.64)ng/L、(9950.21±7118.21)ng/L、(6.79±3.00)mg/L,高于生存组,P均<0.05.Spearman相关性分析显示PCT、NT-pro-BNP、LAC与患者的生存转归呈负相关,r分别为-0.597、-0.323、-0.505,P均<0.05.ROC曲线显示:PCT的Cutoff值12.25 ng/L,灵敏度为0.998,特异度为0.698.NT-pro-BNP的Cutoff值2372.50 ng/L,灵敏度为0.963,特异度为0.488.LAC的Cutoff值2.8 mg/L,灵敏度为0.999,特异度为0.628.结论脓毒症患者PCT、NT-pro-BNP、LAC明显增高,联合检测PCT、NT-pro-BNP、LAC具有判断ICU脓毒症患者预后的价值.

Objective To investigate the clinical significance of procalcitonin(PCT),N-terminal precursor natriuretic peptide(NT-pro-BNP),lactic acid(Lac)in sepsis patients of ICU and the value of prognosis evaluation of them.Methods Total 70 cases of sepsis patients were collected in the Department of Critical Care Medicine of our hospital between April 2016 and April 2018(observation group);at the same time 30 cases of healthy physical examination were enrolled(control group).Venous blood was extracted from sepsis patients to detect PCT,NT-pro-BNP and LAC when they entered ICU,and fasting venous blood was extracted from the control group to detect PCT,NT-pro-BNP and LAC,and the differences between the two groups were compared.The observation group was divided into survival group and death group.The differences of PCT,NT-pro-BNP and LAC were compared between the two groups.Spearman test was used for correlation analysis of PCT,NT-pro-BNP and LAC in patients with survival and mortality.ROC curve was used to evaluate the value of PCT,NT-pro-BNP and LAC in the prognosis of sepsis patients.Results PCT,NT-pro-BNP and LAC in the observation group were(23.00±27.60)ng/L,(7665.50±8084.83)ng/L and(4.59±3.47)mg/L,respectively,higher than the control group(P<0.05).PCT,NT-pro-BNP and LAC were(45.65±30.64)ng/L,(9950.21±7118.21)ng/L and(6.79±3.00)mg/L respectively in the death group,higher than that in the survival group(P<0.05).Spearman correlation analysis showed that PCT,NT-pro-BNP and LAC were negatively correlated with the survival outcome of patients,with r being-0.597,-0.323 and-0.505,respectively(P<0.05).The ROC curve showed that the cutoff value of PCT was 12.25 ng/L,the sensitivity was 0.998,and the specificity was 0.698;the cutoff value of NT-pro-BNP was 2372.50 ng/L,the sensitivity was 0.963,and the specificity was 0.488;the cutoff value of LAC was 2.8 mg/L,the sensitivity was 0.999,and the specificity was 0.628.Conclusion PCT,NT-pro-BNP and LAC in sepsis patients are significantly increased,and combined detection of PCT,nt-pro-bnp and LAC have a certain value in prognostic evaluation of sepsis patients.