| 心房钠尿肽对脓毒症早期诊断、严重程度及预后的临床应用价值 |
| 投稿时间：2014-08-28 修订日期：2014-09-10 点此下载全文 |
| 引用本文：王虎,夏修军,王龚奋飞,朱焱.心房钠尿肽对脓毒症早期诊断、严重程度及预后的临床应用价值[J].医学研究杂志,2015,44(11):47-51 |
| DOI：
10.11969/j.issn.1673-548X.2015.11.013 |
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| 基金项目:国家自然科学基金资助项目(81371439) |
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| 中文摘要:目的 探讨心房钠尿肽(atrial natriuretic peptide,ANP)对脓毒症的早期诊断作用及其在评估脓毒症严重程度及预后的临床应用价值。方法 连续收集笔者院内科重症监护病房(intensive care unit,ICU)近期收治的86例全身炎性反应或脓毒症患者进行研究。根据诊断时的病情分为:全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)组(34例)、脓毒组(26例)、重症脓毒症组(26例)。于入院后立即抽取静脉血,检测血清中ANP、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)和乳酸的水平,并计算急性生理和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation,APACHE Ⅱ)。比较各组血清标志物和APACHEⅡ评分的差异,采用逐步回归分析影响疾病严重程度的危险因素,比较不同预后情况的患者的各指标差异。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析各指标对脓毒血症的诊断价值。结果 脓毒组、重症脓毒症组ANP、PCT、CRP和乳酸水平及APACHE Ⅱ评分均高于SIRS组,差异有统计学意义(P<0.05)。重症脓毒症组ANP、PCT、CRP和乳酸水平及APACHE Ⅱ评分均高于脓毒组,差异有统计学意义(P<0.05)。86例患者死亡16例,死亡组ANP、PCT、CRP和乳酸水平均及APACHE Ⅱ评分高于存活组,差异有统计学意义(P<0.05)。逐步回归显示APACHE Ⅱ和ANP与脓毒症严重程度均呈正相关(P<0.05)。ROC曲线分析显示,ANP曲线下面积与APACHE Ⅱ相近,分别为0.873和0.897(P=0.000)。结论 检测ANP有利于脓毒症的早期诊断和评估脓毒症的严重程度,可作为判断脓毒症预后的参考指标。 |
| 中文关键词:心房钠尿肽 脓毒症 早期诊断 预后 |
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| Values of Early Diagnosis, Severity Assessment and Prognosis of Sepsis by Atrial Natriuretic Peptide. |
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| Abstract:Objective To investigate the effect of atrial natriuretic peptide(ANP) in early diagnosis and assessment of severity and prognosis of sepsis. Methods Eighty cases of sepsis patients treated in the Department of internal medicine of hospital intensive care unit(ICU) were selected for prospective study. According to the diagnosis criteria of sepsis, patients were divided into:systemic inflammatory response syndrome(SIRS) group(n=34), sepsis group(n=26), and severe sepsis group(n=26). Venous blood samples of patients were drawn to detect serum concentration of ANP, procalcitonin(PCT), C-reactive protein(CRP) and the level of lactate acid, and calculate the acute physiology and chronic health evaluation(APACHE Ⅱ). APACHE Ⅱ score and biomarkers were compared in each group. Stepwise regression was used to confirm risk factor for severity, and the value of each biomarker in early diagnosis of sepsis was analyzed with receiver operating characteristic(ROC) curve. Results Concentration of ANP, PCT, CRP lactate acid level and APACHE Ⅱ score in sepsis group and severe sepsis group were higher than those in SIRS group, and the difference was statistically significant(P<0.05). Concentration of ANP, PCT, CRP,lactate acid level and APACHE Ⅱ score in severe sepsis group were higher than those in sepsis group, the difference was statistically significant(P<0.05).Sixteen patients died, and concentration of ANP, PCT, CRP, lactate acid level and APACHE Ⅱ score in death group were higher than those in survival group, the difference was statistically significant(P<0.05). Stepwise regression analysis showed that APACHE Ⅱ and ANP were positively associated with the severity of sepsis in(P<0.05). ROC curve analysis of biomarkers in the sepsis patients, the area under curve for ANP(0.873, P=0.000) was similar with that for APACHE Ⅱ(0.897, P=0.000). Conclusion The severity of detection of ANP is conducive to the early diagnosis of sepsis and sepsis, and may be used as a reference index for judging the prognosis of sepsis. |
| keywords:Atrial natriuretic peptide Sepsis Early diagnosis Prognosis |
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