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Presepsin与B型钠尿肽评估脓毒血症患者病情及综合干预后预后的比较
作者:陈丽丽1  陈炜2  李云萍3 
单位:1. 首都医科大学附属北京世纪坛医院 日间手术中心, 北京 100038;
2. 首都医科大学附属北京世纪坛医院 ICU, 北京 100038;
3. 中国医学科学院阜外医院 ICU, 北京 100037
关键词:可溶性白细胞分化抗原14亚型 B型钠尿肽 脓毒血症 预后 
分类号:R631
出版年·卷·期(页码):2018·46·第十期(1123-1128)
摘要:

目的:观察比较可溶性白细胞分化抗原14亚型(sCD14-ST,即presepsin)和B型钠尿肽在评估脓毒血症患者病情及综合干预措施处理后预后中的差异。方法:纳入脓毒血症患者86例及健康对照组31例,将脓毒血症患者根据疾病严重程度分为普通脓毒血症组50例和严重脓毒血症合并休克组36例;按30 d死亡的结局再将患者分为生存组75例和死亡组11例。所有脓毒血症患者均在ICU接受综合干预措施治疗,并在入院时检测血浆presepsin、B型钠尿肽水平及进行急性生理和慢性健康状况评分表(APACHE)Ⅱ评分评估。结果:严重脓毒血症合并休克组presepsin、B型钠尿肽水平及APACHEⅡ评分均高于普通脓毒血症组及健康对照组(P<0.01),死亡组上述3种指标均高于生存组(P<0.01)。presepsin诊断普通脓毒血症、严重脓毒血症合并休克的敏感性、特异性、诊断正确率均高于B型钠尿肽及APACHEⅡ评分(P<0.05)。在判断30 d死亡结局方面,3个指标差异无统计学意义(P>0.05)。结论:presepsin与B型钠尿肽均能有效评估脓毒血症患者病情程度及预后,presepsin评估病情更准确,而在预测死亡结局方面两指标效果相近。

Objective:To observe the difference between presepsin and B-type natriuretic peptide in evaluating the severity of sepsis and assessing prognosis after comprehensive intervention. Methods:Eight-six septic patients and 31 healthy control subjects were included in this study. The 86 septic patients were divided into general sepsis group (50 cases) and severe sepsis and septic shock group (36 cases) according to the severity of sepsis. And the 86 septic patients were subdivided into survival group (75 cases) and death group (11 cases) in accordance with death outcome at 30 days. All patients with sepsis were treated with comprehensive intervention in intensive care unit in our hospital. APACHE Ⅱ score, plasma presepsin and B-type natriuretic peptide levels were measured at admission. Results:APACHE Ⅱ score, plasma presepsin and B-type natriuretic peptide levels in the severe sepsis and septic shock group were higher than those in the general sepsis group and the healthy control group (P<0.01),and they were higher in the death group than those in the survival group (P<0.01). The sensitivity, specificity and diagnostic accuracy of presepsin in the diagnosis of general sepsis and severe sepsis and shock were higher than those of B-type natriuretic peptide and APACHE Ⅱ score (P<0.05). However, there were no significant differences among the three indexes in assessing the death outcome at 30 days (P>0.05). Conclusion:Both the presepsin and B-type natriuretic peptide can evaluate the severity and prognosis outcome of septic patients effectively. Presepsin is more accurate in evaluating the severity of sepsis,while presepsin and B-type natriuretic peptide have similar predictive value for the death outcome.

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