不同程度脓毒血症患者血浆BNP水平的变化及其临床意义

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.

The clinical significance of the change of plasma BNP levels in patients with grades sepsis

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.