CAJ | 학술논문

目的：探讨脓毒症患者B型尿钠肽（BNP）和心肌肌钙蛋白I（cTnI）的变化与患者预后的关系。方法回顾性分析入住温州医科大学附属第一医院急诊重症监护病房（EICU）75例严重脓毒症、脓毒性休克患者的临床资料。按病情严重程度将患者分为严重脓毒症组（34例）和脓毒性休克组（41例），按预后分为存活组（32例）和死亡组（43例）。患者入院24 h内进行心电图检查；比较各组急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和器官功能不全标志物BNP、cTnI、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸水平的变化。结果脓毒性休克组BNP、cTnI、乳酸、APACHEⅡ评分和病死率均较严重脓毒症组明显升高〔BNP（μg/L）：1.90（1.08，2.79）比0.41（0.31，0.75），cTnI（μg/L）：1.15（0.92，1.28）比0.58（0.40，0.79），乳酸（mmol/L）：6.63±3.72比3.28±1.66，APACHEⅡ评分（分）：26.00（24.00，28.00）比21.50（20.00，29.25），病死率：70.73%比41.18%，P＜0.05或P＜0.01〕，死亡组性别、年龄、BNP、乳酸、cTnI和APACHEⅡ评分都高于存活组〔男性（例）：30比13，年龄（岁）：66.49±14.97比58.19±17.05，BNP：1.60（0.62，2.51）比0.57（0.37，1.79），乳酸：4.10（3.00，9.00）比3.10（2.13，4.18），cTnI：1.02±0.49比0.62±0.37，APACHEⅡ评分：28.00（25.00，30.00）比21.00（20.00，25.75），P＜0.05或P＜0.01〕，而不同疾病严重程度和不同预后患者CK、CK-MB水平差异均无统计学意义（均P＞0.05）。急诊心电图检查无特异性变化。结论脓毒症患者BNP和cTnI升高提示出现心肌损伤和较差的预后。检测BNP和cTnI可能有助于早期识别脓毒症心功能不全的高危患者并有助于预后的评估。
목적：탐토농독증환자B형뇨납태（BNP）화심기기개단백I（cTnI）적변화여환자예후적관계。방법회고성분석입주온주의과대학부속제일의원급진중증감호병방（EICU）75례엄중농독증、농독성휴극환자적림상자료。안병정엄중정도장환자분위엄중농독증조（34례）화농독성휴극조（41례），안예후분위존활조（32례）화사망조（43례）。환자입원24 h내진행심전도검사；비교각조급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분화기관공능불전표지물BNP、cTnI、기산격매（CK）、기산격매동공매（CK-MB）、유산수평적변화。결과농독성휴극조BNP、cTnI、유산、APACHEⅡ평분화병사솔균교엄중농독증조명현승고〔BNP（μg/L）：1.90（1.08，2.79）비0.41（0.31，0.75），cTnI（μg/L）：1.15（0.92，1.28）비0.58（0.40，0.79），유산（mmol/L）：6.63±3.72비3.28±1.66，APACHEⅡ평분（분）：26.00（24.00，28.00）비21.50（20.00，29.25），병사솔：70.73%비41.18%，P＜0.05혹P＜0.01〕，사망조성별、년령、BNP、유산、cTnI화APACHEⅡ평분도고우존활조〔남성（례）：30비13，년령（세）：66.49±14.97비58.19±17.05，BNP：1.60（0.62，2.51）비0.57（0.37，1.79），유산：4.10（3.00，9.00）비3.10（2.13，4.18），cTnI：1.02±0.49비0.62±0.37，APACHEⅡ평분：28.00（25.00，30.00）비21.00（20.00，25.75），P＜0.05혹P＜0.01〕，이불동질병엄중정도화불동예후환자CK、CK-MB수평차이균무통계학의의（균P＞0.05）。급진심전도검사무특이성변화。결론농독증환자BNP화cTnI승고제시출현심기손상화교차적예후。검측BNP화cTnI가능유조우조기식별농독증심공능불전적고위환자병유조우예후적평고。
Objective To evaluate the relationship between changes in B-type natriuretic peptide(BNP) and cardiac troponin I(cTnI)levels and prognosis of critically ill patients with sepsis. Methods This study retrospectively reviewed the clinical data of 75 patients with severe sepsis and septic shock admitted into Emergency Intensive Care Unit(EICU)of the First Affiliated Hospital of Wenzhou Medical University in Zhejiang Province. According to the severity of the cases,they were divided into two groups:severe sepsis group(34 cases)and septic shock group(41 cases),and based on the difference in prognosis,they were divide into survivor group(32 cases) and non-survivor group(43 cases). Electrocardiogram(ECG)was performed within 24 hours after admission in all the patients. Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score and biochemical markers showing organ dysfunctions as BNP, cTnI, creatine kinase (CK), creatine kinase MB mass(CK-MB), and lactate were compared between severe sepsis and septic shock groups and between survivor and non-survivor groups. Results The septic shock group had significantly higher baseline BNP,cTnI,lactate and APACHE Ⅱscore and mortality rate than those in severe sepsis group〔BNP(μg/L):1.90(1.08,2.79)vs. 0.41(0.31,0.75),cTnI (μg/L):1.15(0.92,1.28)vs. 0.58(0.40,0.79),lactate(mmol/L):6.63±3.72 vs. 3.28±1.66,APACHEⅡscore:26.00(24.00,28.00)vs. 21.50(20.00,29.25),mortality rate:70.73%vs. 41.18%,P<0.05 or P<0.01〕. Compared with survivor group,the ages of non-survivor group were older with more males and higher BNP,cTnI,lactate and APACHEⅡscore〔males(cases):30 vs. 13,age(years old):66.49±14.97 vs. 58.19±17.05,BNP:1.60(0.62, 2.51)vs. 0.57(0.37,1.79),lactate:4.10(3.00,9.00)vs. 3.10(2.13,4.18),cTnI:1.02±0.49 vs. 0.62±0.37, APACHE Ⅱ score:28.00(25.00,30.00)vs. 21.00(20.00,25.75),P<0.05 or P<0.01〕. However,there were no statistically significant differences in the levels of CK and CK-MB between the above compared groups(both P>0.05). The patients' ECGs had no obvious changes. Conclusions High plasma BNP and cTnI levels in patients with sepsis may suggest myocardial damage and relatively bad prognosis. The examination of BNP and cTnI levels may help clinicians to early detect the high-risk patients with septic cardiac dysfunction and assess their prognoses.