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| 血清降钙素原、N前端脑钠肽和APACHEⅡ评分预测脓毒症相关性脑病的价值 |
| Predictive and estimated value of procalcitonin, N-terminal precursor natriuretic peptide, and acute physiology and chronic health evaluation system Ⅱ for sepsis associated encephalopathypatients |
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| DOI：10.12089/jca.2019.11.002 |
| 中文关键词: 脓毒症相关性脑病 降钙素原 N前端脑钠肽 乳酸 急性生理学与慢性健康状况评分系统Ⅱ |
| 英文关键词: Sepsis associated encephalopathy Procalcitonin N-terminal precursor natriuretic peptide Lactic acid Acute physiology and chronic health evaluation system Ⅱscore |
| 基金项目:国家自然科学基金(81772126);江苏省卫生厅课题(YG201409);江苏大学附属金坛医院院级课题(YJKT2017002) |
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| 中文摘要: |
目的 观察脓毒症患者血清降钙素原(PCT)、N前端脑钠肽(NT-pro-BNP)、乳酸(Lac)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)指标,探讨其对ICU脓毒症相关性脑病(SAE)患者预测评估的价值。
方法 选择ICU收治的脓毒症患者217例,男133例,女84例,年龄29～95岁,BMI 17～31 kg/m2,ASA Ⅳ级。所有患者治疗方法按脓毒症诊治规范中推荐的容量复苏、抗感染、脏器功能支持等进行。根据SAE诊断标准分为SAE组(S组,n=97)和非SAE组(NS组,n=120)。比较两组患者入ICU时PCT、NT-pro-BNP、Lac和APACHEⅡ评分差异。采用多因素Logistic回归分析方法对观察指标作危险因素分析。采用受试者工作特征曲线(ROC)评估PCT、NT-pro-BNP、Lac和APACHEⅡ最佳临界值,以区别SAE与非SAE患者。同时比较两组患者30 d病死率。
结果 两组患者年龄、性别、BMI、受教育程度、慢性基础疾病、感染部位、ICU停留时间等差异无统计学意义。S组PCT、NT-pro-BNP、Lac和APACHEⅡ评分明显高于NS组(P<0.01)。其中PCT(OR=1.504,95％CI 1.225～1.846,P<0.001)、NT-pro-BNP(OR=1.187,95％CI 1.007～1.399,P=0.041)和APACHEⅡ评分(OR=3.676,95％CI 2.383～5.669,P<0.001)是SAE发生的独立危险因素。PCT指标的敏感度为89.7％,特异度为67.5％。NT-pro-BNP的敏感度为74.2％,特异度为76.7％。APACHEⅡ评分指标的敏感度为88.7％,特异度为93.3％。S组30 d病死率明显高于NS组(P<0.05)。
结论 SAE患者PCT、NT-pro-BNP、Lac、APACHEⅡ评分明显高于非SAE患者,PCT、NT-pro-BNP、APACHEⅡ评分是发生SAE的独立危险因素,可作为并发SAE的预测与评估指标。 |
| 英文摘要: |
Ojective To observe procalcitonin (PCT), N-terminal precursor natriuretic peptide (NT-pro-BNP), lactic acid (Lac), acute physiology andchronic health evaluation system Ⅱ (APACHE Ⅱ) score of patients with sepsis,and study the meaning of these indicators for the diagnosis and treatment of encephalopathy (SAE) in patients with sepsis in the ICU.
Methods A total of 217 patients with sepsis admitted to ICU, including 133 males and 84 females, aged 29-95 years, BMI 17-31 kg/m2, falling into ASA physical status Ⅳ were selected. All patients were treated by volume resuscitation, anti-infection and organ function support recommended in the criteria for sepsis diagnosis and treatment. According to the diagnostic criteria of SAE, the patients were divided into SAE group (group S, n=97) and non-SAE group (group NS, n = 120). We compared PCT, NT-pro-BNP, Lac and APACHE Ⅱ score between the two groups. Multivariate logistic regression analysis was used to analyze the risk factors for SAE.Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff value of plasma PCT, NT-pro-BNP, Lac and APACHEⅡscoreto distinguish the SAE and non-SAE patients. Also 30-day mortality was compared.
Results There were no significant differences in age, sex, BMI, education level, chronic underlying diseases, infection site and ICU time between the two groups. The PCT, NT-pro-BNP, Lac, and APACHE Ⅱ score in group S were higher than group NS (P < 0.05).PCT(OR=1.504,95％CI 1.225-1.846, P<0.001), NT-pro-BNP(OR=1.187,95％CI 1.007-1.399, P = 0.041) and APACHE Ⅱ score(OR=3.676,95％CI 2.383-5.669,P < 0.001) are independent risk factors for SAE. The sensitivity and specificity of PCT were 89.7％ and 67.5％ respectively.The sensitivity and specificity ofNT-pro-BNP were 74.2％ and 76.7％ respectively.The sensitivity and specificity of the APACHE Ⅱscore were 88.7％ and 93.3％.The mortality of group S was higher than group NS (P < 0.05).
Conclusion PCT, NT-pro-BNP, Lac and APACHE Ⅱ score of SAE patients are significantly higher, compared with the non-SAE patients. PCT, NT-pro-BNPand APACHE Ⅱ score are independent risk factors of concurrent SAE, Which can be used as concurrent SAE prediction and evaluation indicators. |
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