CAJ | 학술논문

目的观察不同程度脓毒血症患者血浆B型钠尿肽(BNP)浓度的改变及其与左心室射血分数(LVEF)的相关性,并探讨其临床意义.方法选择台州医院重症监护室(ICU)脓毒血症患者100例作为研究对象,按病情程度分为:脓毒血症性休克组30例,严重脓毒血症组40例,脓毒血症组30例,对照组为自愿健康体检者20例.采用双抗夹心免疫荧光法测定血浆BNP浓度,并进行超声心动图检查,评价心功能.比较各组BNP浓度的差异以及各组BNP浓度与LVEF的相关性,并比较28 d死亡组和存活组患者的临床特征及差异,用受试者工作特征曲线(ROC曲线)评价BNP水平对死亡的预测作用.结果脓毒血症性休克组血浆BNP水平[(976.3±160.7)pg/ml]明显高于严重脓毒血症组[(648.4±267.3)pg/ml]、脓毒血症组[(217.2±89.7)pg/ml]及对照组[(50.3±25.4)pg/ml](P＜0.01),脓毒症性休克组LVEF[(48.2±9.6)%]明显低于严重脓毒血症组[(52.8±9.4)%]、脓毒血症组[(61.3±8.9)%]及对照组[(66.4±9.3)%](P＜0.05或P＜0.01),脓毒血症性休克和严重脓毒血症二组LVEF与血浆BNP水平呈负相关(r=-0.876,-0.724,P＜0.01).死亡组患者BNP水平明显高于存活组[(1367.6±506.4)pg/ml vs(420.3±82.6)pg/ml,P＜0.01].BNP水平与28 d死亡率的ROC曲线分析显示BNP水平的曲线面积为0.918(P＜0.01).结论不同程度脓毒血症患者血浆BNP浓度存在差异,血浆BNP浓度与LVEF呈负相关,血浆BNP水平对脓毒血症患者预后具有预测价值.
목적 관찰불동정도농독혈증환자혈장B형납뇨태(BNP)농도적개변급기여좌심실사혈분수(LVEF)적상관성,병탐토기림상의의.방법 선택태주의원중증감호실(ICU)농독혈증환자100례작위연구대상,안병정정도분위:농독혈증성휴극조30례,엄중농독혈증조40례,농독혈증조30례,대조조위자원건강체검자20례.채용쌍항협심면역형광법측정혈장BNP농도,병진행초성심동도검사,평개심공능.비교각조BNP농도적차이이급각조BNP농도여LVEF적상관성,병비교28 d사망조화존활조환자적림상특정급차이,용수시자공작특정곡선(ROC곡선)평개BNP수평대사망적예측작용.결과 농독혈증성휴극조혈장BNP수평[(976.3±160.7)pg/ml]명현고우엄중농독혈증조[(648.4±267.3)pg/ml]、농독혈증조[(217.2±89.7)pg/ml]급대조조[(50.3±25.4)pg/ml](P＜0.01),농독증성휴극조LVEF[(48.2±9.6)%]명현저우엄중농독혈증조[(52.8±9.4)%]、농독혈증조[(61.3±8.9)%]급대조조[(66.4±9.3)%](P＜0.05혹P＜0.01),농독혈증성휴극화엄중농독혈증이조LVEF여혈장BNP수평정부상관(r=-0.876,-0.724,P＜0.01).사망조환자BNP수평명현고우존활조[(1367.6±506.4)pg/ml vs(420.3±82.6)pg/ml,P＜0.01].BNP수평여28 d사망솔적ROC곡선분석현시BNP수평적곡선면적위0.918(P＜0.01).결론 불동정도농독혈증환자혈장BNP농도존재차이,혈장BNP농도여LVEF정부상관,혈장BNP수평대농독혈증환자예후구유예측개치.
Objective To study the clinical significance of the change of plasma BNP levels in patients with grades sepsis and its correlation with the left ventricular ejection fraction.Methods One hundred patients of sepsis who were admitted in intensive care unit of Taizhou hospital were selected.It was divided into four groups:30 patients with septic shock,40 patients with severe sepsis,30 patients with sepsis and 20 persons without disease as control group.The concentration of plasma BNP was determined using sandwich immunoflurescence,and ultrasonic cardiogram was used to evaluate heart function and clinical features in all groups.To compare with the differences of the concentration of plasma BNP and the correlation between the concentration of Plasma BNP and LVEF in all groups,the data of clinical features,28-day mortality,prognostic values of BNP and the length of stay (ROG) in ICU were collected and compared.Result Plasma BNP levels in patients with septic shock[ (976.3 ± 160.7) pg/ml] were obvious higher than severe sepsis[ (648.4 ± 267.3) pg/ml ],sepsis [ (217.2 ± 89.7) pg/ml ] and control group [ (50.3 ± 25.4)pg/ml] (P ＜0.01).LVEF in patients with septic shock [ (48.2 ±9.6)% ] was obvious lower than severe sepsis[ (52.8 ±9.4)% ],sepsis[ (61.3 ± 8.9)% ] and control group[ (66.4 ±9.3)% ] (P ＜0.05 or P ＜0.01).It appeared to be inverse relationship between LVEF and the plasma BNP levels (r =-0.876,-0.724,P ＜0.01).BNP levels were significantly higher in non-survivors compared with survivors[ (1367.6±506.4)pg/ml vs (420.3 ±82.6)pg/ml,P ＜0.01 ].The receiver operating characteristic (ROG) curves indicated that values of areas under the curve of plasma BNP levels for 28-days mortality were 0.918(P ＜0.01).Conclusion The concentration of plasma BNP in patients was different in different grades of sepsis.It appeared to be negative correlation between the concentration of plasma BNP and LVEF.Plasma BNP levels had predictive value to the patients with sepsis.