血清PCT、NT-proBNP及TCD在脓毒症相关性脑病监测中的应用及对其转归的预测价值

Application of serum PCT,NT-proBNP and TCD in monitoring sepsis associated encephalopathy and predicting its prognosis

目的探讨血清降钙素原(PCT)、N前端脑钠肽(NT-proBNP)及经颅多普勒超声(TCD)在脓毒症相关性脑病(SAE)监测中的应用及对其转归的预测价值。方法选取本院2020年1月—2022年4月收治的脓毒症患者148例作为研究对象,根据是否合并SAE分为SAE组(67例)与无SAE组(81例)。采用免疫发光法测定血清PCT水平,酶联免疫吸附法测定血清NT-proBNP水平;采用TCD测定收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)和阻力指数(RI);记录SAE患者30 d转归情况,以患者病情进展或死亡为转归不良,反之为转归良好。结果SAE组患者APACHEⅡ评分高于无SAE组(P<0.05)。SAE组患者血清PCT和NT-proBNP水平高于无SAE组(P<0.05)。SAE组患者Vs、Vd和Vm低于无SAE组,而RI高于无SAE组(均P<0.05)。转归不良组患者血清PCT和NT-proBNP水平高于转归良好组(P<0.05)。转归不良组患者Vs、Vd和Vm低于转归良好组,而RI高于转归良好组(均P<0.05)。经ROC曲线分析,SAE诊断中,PCT敏感度为82.13%,特异度为95.12%;NT-proBNP敏感度为98.52%,特异度为97.51%。结论SAE患者血清PCT和NT-proBNP水平升高,且存在脑血流动力学异常及与转归密切相关,可作为预测SAE患者及对转归提供参考指标。

Objective To explore the application of serum procalcitonin(PCT),NT-proBNP and Transcranial Doppler(TCD)in monitoring sepsis related encephalopathy(SAE)and its predictive value for its prognosis.Methods The 148 patients with sepsis treated in our hospital from January 2020 to April 2022 were selected as the research objects.According to whether SAE was combined or not,they were divided into SAE group(67 cases)and non SAE group(81 cases).Serum PCT and NT-proBNP levels were measured by immunoluminescence assay and enzyme-linked immunosorbent assay respectively.Peak systolic blood flow velocity(VS),end diastolic blood flow velocity(VD),mean blood flow velocity(VM)and resistance index(RI)were measured by TCD.The 30 day prognosis of SAE patients was recorded.The poor prognosis was based on the progress of the patient′s condition or death,otherwise,it was a good prognosis.Results SAE group APACHEⅡwas score higher than non SAE group(P<0.05).SAE group serum PCT and NT-proBNP were higher than non SAE group(P<0.05).SAE group Vs,Vd and Vm of patients were lower than non SAE group,while RI of patients was higher than non SAE group(P<0.05).The poor prognosis serum PCT and NT-proBNP in patients were higher than good prognosis(P<0.05).The poor prognosis Vs,Vd and Vm of patients were lower than patients with good prognosis,while the RI of patients with poor prognosis was higher than patients with good prognosis(P<0.05).The sensitivity and specificity of PCT in SAE diagnosis were 82.13%and 95.12%respectively.The sensitivity and specificity of NT proBNP were 98.52%and 97.51%,respectively.Conclusion The levels of serum PCT and NT-proBNP in patients with SAE are increased,and there are abnormal cerebral hemodynamics,which are closely related to the prognosis,it can be used as a reference index to predict the patients with SAE and their prognosis.