老年脓毒症患者血清氨基末端脑钠肽前体升高的影响因素分析

Analysis of Factors Affecting Elevated Serum Amino-terminal Brain Natriuretic Peptide Precursors in Elderly Patients with Sepsis

目的探讨影响老年脓毒症患者NT-proBNP升高的影响因素。方法采用回顾性研究分析2017年10月—2019年12月福建省老年医院收治的老年脓毒症患者114例的临床资料。根据患者确诊入院时的血清NT-proBNP水平是否升高,将其分为观察组(NT-proBNP升高)60例和对照组(NT-proBNP正常)54例。收集患者的人口学特征以及既往病史、BMI、是否有脓毒性休克及SOFA评分、APACHEⅡ评分等。入院时采集患者外周静脉血,送检血清肌酐、NT-proBNP、心肌损伤标志物、炎症指标、心肌抑制因子、心肌自身免疫抗体等指标。以单因素和多因素分析老年脓毒症患者NT-proBNP的影响因素。结果与对照组比较,观察组的脓毒性休克占比、SOFA评分、APACHEⅡ评分、CK-MB、cTnI、PCT、CRP、IL-1β、TNF-α、β1-AAB、M2-AA显著较高,Ccr水平更低,差异有统计学意义(P<0.05)。Logistic多因素回归分析结果表明老年脓毒症患者NTproBNP水平的独立影响因素为PCT、IL-1β、BMI、Ccr(P<0.05)。结论老年脓毒症患者NT-proBNP的升高与BMI、PCT、IL-1β、Ccr指标相关,上述指标是老年脓毒症患者NT-proBNP升高的影响因素,但这些发现需要样本量更大的前瞻性研究进一步验证。

Objective To investigate the influencing factors affecting the elevation of NT-proBNP in elderly patients with sepsis.Methods A retrospective study was used to analyze the clinical data of 114 cases of geriatric sepsis patients admitted to Fujian Provincial Geriatric Hospital from October 2017 to December 2019.The patients were divided into 60 cases in the observation group(elevated NT-proBNP)and 54 cases in the control group(normal NTproBNP)according to whether their serum NT-proBNP levels were elevated at the time of confirmed admission.The patients'demographic characteristics as well as past medical history,BMI,presence of septic shock and SOFA score and APACHEⅡscore were collected.Peripheral venous blood was collected from patients on admission and sent for serum creatinine,NT-proBNP,myocardial injury markers,inflammatory indexes,myocardial inhibitory factors,and myocardial autoimmune antibodies.Analyzed the influencing factors of NT proBNP levels in elderly sepsis patients using single and multiple factors.Results Compared with the control group,septic shock percentage,SOFA score,APACHEⅡscore,CK-MB,cTnI,PCT,CRP,IL-1β,TNF-α,β1-AAB,and M2-AA in the observation group were significantly higher,Ccr levels was lower,the difference was statistically significant(P<0.05).Logistic multi-factor regression analysis showed that PCT,IL-1β,BMI and Ccr were independent influencing factors of NT-proBNP levels(P<0.05).Conclusion Elevated NT-proBNP in elderly patients with sepsis was correlated with BMI,PCT,IL-1β,and Ccr indicators,and the above indicators may be influential factors in elevated NT-proBNP in elderly patients with sepsis,but these findings need further validation in prospective studies with larger sample sizes.