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论著:N末端前体脑钠肽在诊断脓毒血症合并心肌损伤中的意义
Changes of N Terminal Pro B Type Natriuretic Peptide in Sepsis Combined with Myocardial Injury
金花 申捷 刘国平 刘明 刘畅
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作者单位:复旦大学附属金山医院急诊科
中文关键字:脓毒血症;N末端前体脑钠肽;心肌损伤
英文关键字:Sepsis; N terminal pro B type natriuretic peptide; Myocardial injury
中文摘要:目的:探讨脓毒血症合并心肌损伤患者血浆N末端前体脑钠肽(N terminal pro B type natriuretic peptide,NT proBNP) 水平变化及其意义。方法:脓毒血症患者36例,根据心肌损伤诊断标准分为心肌损伤组 (n=22 )和非心肌损伤组 (n=14 ),并选取20例同期非脓毒症住院患者作为对照组。比较各组的血肌酸激酶(reatine kinase MB fraction, CK MB)、心肌肌钙蛋白T(cardiac troponin T, cTnT)以及血浆NT proBNP。结果:脓毒症合并心肌损伤组的血浆NT proBNP为(872.12±235.47) pg/mL、CK MB为(13.79±8.23) μg/mL和cTnT为(0.92±1.69)μg/mL ;与另外2组相比差异均有统计学意义(P<0.05)。脓毒血症患者NT proBNP、CK MB和cTnT水平与对照组相比,差异均有统计学意义(P<0.05)。脓毒血症患者血浆的NT proBNP水平与cTnT水平呈显著正相关(r=0.74,P=0.0001)。采用受试者工作特征曲线(receive operating characteristic curve, ROC)曲线对脓毒血症患者的血浆NT proBNP水平进行分析,ROC曲线下面积(area under curve,AUC)为0.987。结论:常规检测血浆NT proBNP联合CK MB和cTnT,能早期诊断脓毒症合并心肌损伤并指导治疗,防止心力衰竭的发生。
英文摘要:Objective: To study the levels of serum N terminal pro B type natriuretic peptide (NT proBNP) in patients with sepsis and myocardial. Methods:A total of 36 patients with sepsis were divided into myocardial injury group(n=22) and non myocardial injury group(n=14). Twenty non sepsis patients were also enrolled as a control group. The levels of NT proBNP, creatine kinase MB fraction (CK MB) and Cardiac troponin T(cTnT)were detected in all patients of the 3 groups. Results: The levels of NT proBNP, CK MB and cTnT in myocardial injury group were significantly higher than those in non myocardial injury group and control group (P< 0.05). Receive operating characteristic (ROC) analysis was carried out, the area under the ROC curve (AUC) of ROC curve for the diagnosis of myocardial injury by NT proBNP in sepsis was 0.987. Conclusions: NT proBNP can be used to diagnose myocardial injury at an early stage in patients with sepsis.
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