重症超声参数与老年脓毒性休克患者血清NT-proBNP、可溶性CD14及胆碱酯酶表达的相关性研究

Study on the correlations between the CCUS parameters and the expressions of serum NT-proBNP, soluble CD14 and cholinesterase in elderly patients with septic shock

目的:探讨重症超声(CCUS)参数与老年脓毒性休克患者血清N末端脑利钠肽原(NT-pro BNP)、可溶性CD14(s CD14)及胆碱酯酶(CHE)表达的相关性。方法:选取医院收治的82例老年脓毒性休克患者纳入观察组,另选取同期82名健康体检者纳入健康对照组。比较两组血清NT-pro BNP、s CD14及CHE表达的相关性,分析各项血清指标与老年脓毒性休克的关联性及与CCUS参数[肺部超声评分(LUS)、血流速度时间积分(VTI)及心输出量(CO)]的相关性,并比较观察组不同预后CCUS参数及血清指标,探讨其对老年脓毒性休克患者预后的预测价值。结果:观察组血清NT-pro BNP及s CD14水平高于健康对照组,CHE水平低于健康对照组,差异有统计学意义(t=16.813,t=12.504,t=11.948;P<0.05);血清NT-pro BNP、s CD14及CHE水平是老年脓毒性休克发生的重要影响因素(OR=4.036,OR=5.110,OR=0.487;P<0.05);老年脓毒性休克患者血清NT-pro BNP和s CD14水平与LUS、VTI及CO呈正相关(r;=0.478,r=0.521,r=0.494;r;=0.467,r=0.517,r=0.482;P<0.05),与LVEF呈负相关(r=-0.379,r=-0.412;P<0.05),CHE与LUS、VTI、CO呈负相关(r=-0.379,r=-0.474,r=-0.452;P<0.05),与LVEF呈正相关(r=0.415,P<0.05);受试者工作特征(ROC)曲线显示,LUS、NT-pro BNP、s CD14及CHE联合预测老年脓毒性休克患者预后的ROC曲线下面积(AUC)值最大(0.883)。结论:CCUS参数与老年脓毒性休克患者血清NTpro BNP、s CD14及CHE水平存在一定相关性,四者联合可作为评估老年脓毒性休克患者预后的可靠性指标。

Objective: To investigate the correlation between the parameters of critical care ultrasound(CCUS) and the expressions of serum N-terminal pro-natriuretic peptide(NT-proBNP), soluble CD14(sCD14) and cholinesterase(CHE) in elderly patients with septic shock. Methods: 82 elderly patients with septic shock who admitted to hospital were selected as the observation group, and 82 healthy persons who underwent physical examination during the same period were selected as the control group. The correlations of serum NT-proBNP, sCD14 and CHE of two groups were compared, and the correlations between above serum indexes and septic shock of elderly patients, and the correlations between above serum indexes and CCUS parameters [lung ultrasound score(LUS), blood flow velocity time integral(VTI) and cardiac output(CO)] were analyzed. And the CCUS parameter and serum indexes of observation group among different prognoses were compared, and the predictive significances of them on the prognosis of early patients with septic shock were further explored. Results: The serum NT-proBNP and sCD14 levels of observation group were significantly higher than those of control group, and CHE levels of observation group was significantly lower than that of control group, and the difference of that between two groups were statistically significant(t=16.813, t=12.504, t=11.948, P<0.05). The serum NT-proBNP,s CD14 and CHE levels are important influence factors on the occurrence of septic shock of elderly persons(OR=4.036,OR=5.110, OR=0.487, P<0.05). The serum NT-proBNP and sCD14 levels were positively correlated with LUS, VTI and CO in elderly patients with septic shock(r;=0.478, r=0.521, r=0.494, r;=0.467, r=0.517, r=0.482, P<0.05),and they were negatively correlated with LVEF(r=-0.379, r=-0.412, P<0.05), respectively. And CHE was negatively correlated with LUS, VTI, CO(r=-0.379, r=-0.474, r=-0.452, P<0.05), respectively, while it was positively correlated with VEF(r=0.415, P<0.05). The ROC curve showed that the area under curve(AUC) of the combination of LUS, NTpro BNP, sCD14 and CHE was the largest in predicting the prognosis of elderly patients with septic shock. Conclusion:There are a certain of correlations between CCUS parameters and serum NT-proBNP, sCD14 and CHE levels in elderly patients with septic shock. The combination of the four indicators can be used as a reliability index in assessing the prognosis of elderly patients with septic shock.