摘要
目的探讨B型尿钠肽(BNP)水平在脓毒症患者预后判断中的价值。方法选取2017年1月~2018年12月我院收治的56例脓毒症患者作为研究对象,依据远期预后(28 d死亡率)的结果将其分为存活组(35例)和死亡组(21例)。比较两组患者的BNP浓度、血乳酸(Lac)、白细胞计数(WBC)以及急性生理学与慢性健康状况系统Ⅱ(A-PACHEⅡ)评分,并对上述有差异性的指标进行多元Logistic回归分析,用受试者工作特征(ROC)曲线评估BNP水平对脓毒症患者死亡的预测作用。结果死亡组患者住院24 h的BNP水平、Lac值和A-PACHEⅡ评分均高于存活组,差异有统计学意义(P<0.05);两组患者的WBC比较,差异无统计学意义(P>0.05)。存活组患者中,BNP<900 ng/L、Lac≤8 mmol/L、A-PACHEⅡ评分≤15分的占比高于死亡组,差异有统计学意义(P<0.05);存活组患者和死亡组患者的年龄及性别占比比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果提示,BNP[β=0.008,OR=1.008,95%CI(0.155,6.547)]、Lac[β=0.034,OR=1.035,95%CI(0.188,5.700)]及A-PACHEⅡ评分[β=1.116,OR=3.053,95%CI(1.201,7.757)]是影响脓毒症预后的危险因素(P<0.05)。BNP≥900 pg/ml为预测死亡切点,ROC曲线敏感度为0.857,特异度为0.886,曲线下面积(AUC)为0.876。结论脓毒症患者血浆BNP水平明显升高,BNP水平、Lac值和A-PACHEⅡ评分是影响脓毒症患者预后的独立危险因素,BNP水平对脓毒症患者死亡率具有较高的预测价值。
Objective To investigate the value of B-type natriuretic peptide(BNP)level in the prognosis of septic patients.Methods From January 2017 to December 2018,56 patients with sepsis admitted to our hospital were selected as research objects,and were divided into survival group(35 cases)and death group(21 cases)according to the long-term prognosis(28 d mortality).BNP concentration,blood lactate(Lac),white blood cell count(WBC),and acute physiology and chronic health evaluationⅡ(A-PACHEⅡ)scores were compared between the two groups.Multivariate Logistic regression analysis was conducted on the above indicators with differences,and ROC curve was used to evaluate the predictive effect of BNP level on the death of septic patients.Results BNP level,Lac value and A-PACHEⅡscore in death group were higher than those in survival group at 24 h after admission,the differences were statistically significant(P<0.05).There was no significant difference in WBC between the two groups(P>0.05).The proportions of BNP<900 ng/L,Lac≤8 mmol/L and A-PACHEⅡscore≤15 points in the survival group were higher than those in the death group,the differences were statistically significant(P<0.05).There were no significant differences in age and gender ratio between patients in survival group and patients in death group(P>0.05).Multivariate Logistic regression analysis showed that BNP(β=0.008,OR=1.008,95%CI[0.155,6.547]),Lac(β=0.034,OR=1.035,95%CI[0.188,5.700]),and A-PACHEⅡscore(β=1.116,OR=3.053,95%CI[1.201,7.757])were risk factors affecting the prognosis of sepsis(P<0.05).BNP≥900 pg/ml was the cut-off point for predicting death,ROC curve sensitivity was 0.857,the specificity was 0.886,and the area under the curve(AUC)was 0.876.Conclusion Plasma BNP level in septic patients is significantly increased.BNP level,Lac value and A-PACHEⅡscore are independent risk factors affecting the prognosis of septic patients.BNP level has high predictive value for mortality of septic patients.
作者
钟雪飞
ZHONG Xue-fei(Department of Emergency,Xinyu People′s Hospital,Jiangxi Province,Xinyu338000,China)
出处
《中国当代医药》
2019年第33期117-119,135,共4页
China Modern Medicine
