血清PCT、CRP、cTnI及NT-proBNP水平与感染性休克患者病情危重程度的相关性研究
Correlation between PCT, CRP, cTnI, NT proBNP levels and severity of septic shock patients

辛璐.血清PCT、CRP、cTnI及NT-proBNP水平与感染性休克患者病情危重程度的相关性研究[J].内科急危重症杂志,2020,26(3):207-211

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DOI：10.11768/nkjwzzzz20200308

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作者	单位	E-mail
辛璐	华中科技大学同济医学院附属武汉市中心医院	844192742@qq.com

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目的：探讨血清降钙素原(PCT)、C反应蛋白(CRP)、心肌肌钙蛋白I(cTnI)及N-末端B型脑钠肽前体(NT-proBNP)水平与感染性休克患者病情危重程度及预后的相关性。方法：回顾性分析72例感染性休克患者的临床资料，根据治疗后30d生存情况将其分为存活组（45例）与死亡组（27例）。观察并比较2组患者入院时及治疗后6、12、24h的血清PCT、CRP、cTnI及NT-proBNP水平及急性生理与慢性健康评估(APCHEⅡ)评分与序贯器官衰竭评估(SOFA)评分，两变量之间的相关性采用Spearman等级相关分析。结果：治疗后6、12、24h，存活组患者血清PCT、CRP、cTnI及NT-proBNP水平较入院时明显降低，而死亡组明显升高(均P＜0.05)；且存活组患者各时间点血清PCT、CRP、cTnI及NT-proBNP水平明显低于死亡组(均P＜0.05)。治疗后6、12、24h，存活组患者APACHEⅡ评分与SOFA评分依次降低，死亡组患者依次升高，且存活组患者各时间点APACHEⅡ评分与SOFA评分明显低于死亡组(均P＜0.05)。Spearman等级相关分析表明，感染性休克患者APACHEⅡ评分与血清PCT、CRP、cTnI及NT-proBNP水平呈正相关性(r值分别为0.563、0.895、0.701、0.627, 均P＜0.05)；SOFA评分与血清PCT、CRP、cTnI及NT-proBNP水平呈正相关性(r值依次为0.547、0.753、0.916、0.708, 均P＜0.05)。多因素Logistic回归分析显示APACHEⅡ评分(OR=2.163, 95%CI:1.271～3.697)、SOFA评分(OR=1.594,95%CI:1.035～2.268)、PCT (OR=2.429,95%CI:1.764～3.271)、CRP(OR=1.568,95%CI:1.023～2.734)、cTnI (OR=1.871,95%CI:1.315～3.498)、NT-proBNP(OR=1.435,95%CI:0.932～1.942)为感染性休克患者预后的独立影响因素(均P＜0.05)。结论：血清PCT、CRP、cTnI及NT-proBNP水平较高的感染性休克患者病情较严重，生存情况较差。APACHEⅡ评分、SOFA评分、血清PCT、CRP、cTnI、NT-proBNP水平均为感染性休克患者预后的独立影响因素。

英文摘要:

Objective: To investigate the correlation between the PCT, CRP, cTnI, NT-proBNP levels and the severity, prognosis of septic shock patients. Methods: The clinical data of 72 septic shock patients were retrospectively analyzed, and according to the survival condition 30 days after treatment, the patients were divided into the survival group (45 cases) and the death group (27 cases). The PCT, CRP, cTnI, NT-proBNP levels and APCHE II score, SOFA score were recorded and compared in two groups at admission time and different time points after treatment (6h, 12h, 24h). The correlation between the two variables were analyzed by Spearman rank correlation analysis. Results: The PCT, CRP, cTnI and NT-proBNP levels in the survival group were significantly lower at 6h, 12h and 24h after treatment than those at admission, and those in the death group were significantly higher (P<0.05). The PCT, CRP, cTnI and NT-proBNP levels in the survival group at different time points were significantly lower than those in the death group (P<0.05). After treatment of 6h, 12h and 24h, the APACHE II scores and SOFA scores in the survival group decreased in turn, but those in the death group increased in turn. The APACHE II scores and SOFA scores in the survival group after treatment of 6h, 12h and 24h were significantly lower than those in the death group respectively (all P<0.05). The Spearman grade correlation analysis showed that APACHE II score in the septic shock patients was positively correlated with PCT, CRP, cTnI and NT-proBNP levels (the values of r were 0.563, 0.895, 0.701, 0.627 respectively, all P<0.05). The SOFA score in the septic shock patients was positively correlated with PCT, CRP, cTnI and NT-proBNP levels (the values of r were 0.547, 0.753, 0.916, 0.708 respectively, all P<0.05). Multivariate logistic regression analysis showed that the APACHE II score (OR=2.163, 95% 〖LM〗CI: 1.271-3.697), SOFA score (OR=1.594, 95% CI: 1.035-2.268), PCT (OR=2.429, 95% CI: 1.764-3.271), CRP (OR=1.568, 95% CI: 1.023-2.734), cTnI (OR=1.871, 95% CI: 1.315-3.498), NT-proBNP (OR=1.435, 95% CI: 0.932-1.942) were independent prognostic factors of septic shock patients (all P<0.05). Conclusion: The severity of septic shock patients with high levels of PCT, CRP, cTnI and NT-proBNP is more serious and the survival condition 30 days after treatment is worse. The APACHE II score, SOFA score, PCT, CRP, cTnI and NT-proBNP were independent prognostic factors of septic shock patients.