摘要
目的探讨脓毒症患者液体复苏治疗前后血清脑钠肽(BNP)、心肌酶、可溶性髓系细胞触发受体-1(sTREM-1)、D-二聚体(D-D)水平的变化及临床意义。方法回顾性选取2016年1月至2018年10月陕西省第四人民医院收治的84例脓毒症患者作为病例组,以同期来院体检的30例正常健康人作为对照组。对照组体检当日、病例组液体复苏前后均采血测定血清BNP、心肌酶学[磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)]、sTREM-1和D-D水平;病例组入院后进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,比较不同严重程度脓毒症患者实验室指标的差异;并按预后分为生存组与死亡组,比较不同预后患者实验室指标、APACHEⅡ评分差异;采用Spearman相关分析法分析各实验室指标与脓毒症病情程度的关系。结果液体复苏前病例组患者和对照组的BNP[(586.23±129.51)pg/mL vs(36.25±10.19)pg/mL]、CK[(1426.56±290.64)U/L vs(102.63±30.47)U/L]、CK-MB[(142.46±38.79)U/L vs(17.63±5.98)U/L]、sTREM-1[(59.87±7.98)pg/mL vs(20.14±3.45)pg/mL]、D-D[(5.72±1.26)μg/mL vs(0.54±0.15)μg/mL]及APACHEⅡ评分[(23.34±6.51)分vs(0.50±0.19)分]比较,病例组明显高于对照组,差异均有统计学意义(P<0.05);脓毒症休克组、严重脓毒症组患者的BNP、CK、CK-MB、LDH、AST、sTREM-1、D-D及APACHEⅡ评分明显高于脓毒症组,脓毒症休克组上述指标又明显高于严重脓毒症组,差异均有统计学意义(P<0.05);复苏后病例组患者的BNP、CK、CK-MB、LDH、AST、sTREM-1、D-D、APACHEⅡ评分明显低于复苏前,差异均有统计学意义(P<0.05);生存组患者复苏前的BNP、CK、CK-MB、LDH、AST、sTREM-1、D-D及APACHEⅡ评分明显低于死亡组,差异均有统计学意义(P<0.05);脓毒症患者复苏前的BNP、CK、CK-MB、LDH、AST、sTREM-1、D-D与APACHEⅡ评分均呈正相关(P<0.05)。结论BNP、CK、CK-MB、LDH、AST、sTREM-1、sTREM-1、D-D参与脓毒症发病及进展过程,且与液体复苏效果及预后密切相关,或可作为预测脓毒症疗效及评估其预后的依据。
Objective To explore the changes and clinical significance of serum brain natriuretic peptide(BNP),myocardial enzymes,soluble triggering receptor expressed on myeloid cells-1(sTREM-1),and D-dimer(D-D)in patients with sepsis before and after fluid resuscitation.Methods Using a retrospective study,84 patients with sepsis(case group)admitted to the Fourth People's Hospital of Shaanxi between January 2016 and October 2018 were selected,and 30 normal healthy persons(control group)who came to the hospital for physical examination during the same period were enrolled.Blood samples were collected from the control group on the day of physical examination and from the cases group before and after fluid resuscitation to measure the levels of serum BNP,myocardial enzymology(creatine kinase[CK],creatine kinase isoenzyme[CK-MB],lactate dehydrogenase[LDH],aspartate aminotransferase[AST]),sTREM-1 and D-D.Acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores of the case group were obtained after admission.The laboratory indicators were compared among patients with sepsis of different severity.The patients were divided into survival group and death group according to the prognosis,and the laboratory indicators and APACHEⅡscores were compared between patients with different prognosis.Spearman correlation analysis was performed to analyze the relationship between laboratory indicators and sepsis severity.Results Before fluid resuscitation,the case group was significantly higher than the control group in the following indexes(all P<0.05):BNP,(586.23±129.51)pg/mL vs(36.25±10.19)pg/mL);CK,(1426.56±290.64)U/L vs(102.63±30.47)U/L;CK-MB,(142.46±38.79)U/L vs(17.63±5.98)U/L;sTREM-1,(59.87±7.98)pg/mL vs(20.14±3.45)pg/mL;D-D,(5.72±1.26)μg/mL vs(0.54±0.15)μg/mL;APACHEⅡscore,(23.34±6.51)points vs(0.50±0.19)points.The BNP,CK,CK-MB,LDH,AST,sTREM-1,D-D,and APACHEⅡscores were significantly higher in septic shock group and severe sepsis group than in sepsis group,and also significantly higher in septic shock group than in severe sepsis group(all P<0.05).After resuscitation,BNP,CK,CK-MB,LDH,AST,sTREM-1,D-D,and APACHEⅡscores in the case group were significantly lower than those before resuscitation(all P<0.05).Besides,the above indexes in the survival group before resuscitation were significantly lower than those in the death group(all P<0.05).The BNP,CK,CK-MB,LDH,AST,sTREM-1,and D-D in patients with sepsis before resuscitation were all positively correlated with APACHEⅡscore(all P<0.05).Conclusion BNP,CK,CK-MB,LDH,AST,sTREM-1,sTREM-1,and D-D participate in the pathogenesis and progression of sepsis,which are closely related to fluid resuscitation effects and the prognosis,suggesting that they may provide a basis for curative effect prediction and prognosis of sepsis.
作者
张东东
李伟妮
ZHANG Dong-dong;LI Wei-ni(Department of Clinical Laboratory,the Fourth People's Hospital of Shaanxi,Xi'an 710043,Shaanxi,CHINA;Radio-immunity Center,Shaanxi Provincial People's Hospital,Xi'an 710068,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第22期2893-2898,共6页
Hainan Medical Journal
基金
陕西省卫生健康委员会基金项目(编号:2017JM10327)。
关键词
脓毒症
液体复苏
脑钠肽
心肌酶学
可溶性髓系细胞触发受体-1
D-二聚体
预后
Sepsis
Fluid resuscitation
Brain natriuretic peptide(BNP)
Myocardial enzymology
Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)
D-dimer(D-D)
Prognosis
