摘要
目的:探讨降钙素原(PCT)、心肌肌钙蛋白(cTnT)、N末端B型利钠肽前体(NT-proBNP)和D-二聚体(D-D)联合检测对感染性休克患者病情及预后的评估价值。方法:选取2021年6月—2023年5月南海区第五人民医院收治的感染性休克患者63例作为研究对象,根据急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分分为观察1组(n=8,<15分)、观察2组(n=29,15~25分)、观察3组(n=26,>25分);根据患者入院后28 d的生存状态分为存活组(n=42)和死亡组(n=21)。比较不同APACHEⅡ评分及生存状态患者PCT、cTnT、NT-proBNP、D-D水平,采用Logistic回归分析感染性休克患者预后的影响因素,绘制预后评估指标的受试者工作特征曲线(ROC),比较ROC下面积(AUC),分析各指标对感染性休克的预后评估价值。结果:观察3组PCT、cTnT、NT-proBNP、D-D水平高于观察1组,cTnT、NTproBNP水平高于观察2组,差异有统计学意义(P<0.05)。存活组PCT、cTnT、NT-proBNP、D-D水平均低于死亡组,差异有统计学意义(P<0.05)。NT-proBNP、D-D水平是感染性休克患者预后的独立影响因素,差异有统计学意义(P<0.05)。PCT、cTnT、NT-proBNP、D-D四项联合检测的AUC高于任一指标单独检测,差异有统计学意义(P<0.05)。结论:PCT、cTnT、NT-proBNP、D-D水平与感染性休克患者病情及预后密切相关,四项指标水平越高说明病情越严重,四项指标联合检测对感染性休克患者的预后评估价值更高。
Objective:To investigate the value of the combined detection of procalcitonin(PCT),troponin T(cTnT),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and D-dimer(D-D)in the assessment of disease condition and prognosis of patients with septic shock.Methods:A total of 63 patients with septic shock admitted to the Fifth People's Hospital of Nanhai District from June 2021 to May 2023 were selected as the study subjects.According to the Acute Physiologic Assessment and Chronic Health EvaluationⅡ(APACHEⅡ)score,they were divided into observation group 1(n=8,<15 points),observation group 2(n=29,15-25 points),and observation group 3(n=26,>25 points).According to the survival status of patients at 28 d after admission,they were divided into survival group(n=42)and death group(n=21).The PCT,cTnT,NT-proBNP and D-D levels of patients with different APACHEⅡscores and survival states were compared.Logistic regression analysis was used to analyze the influencing factors of the prognosis of patients with septic shock.The receiver operating characteristic curve(ROC)of the prognosis assessment index was plotted,the area under ROC(AUC)was compared,and the value of each index on the septic shock prognosis assessment was analyzed.Results:The levels of PCT,cTnT,NT-proBNP and D-D in the observation group 3 were higher than those in the observation group 1,and the levels of cTnT and NT-proBNP in the observation group 3 were higher than those in the observation group 2,and the differences were statistically significant(P<0.05).The levels of PCT,cTnT,NT-proBNP and D-D in the survival group were lower than those in the death group,and the differences were statistically significant(P<0.05).NT-proBNP and D-D levels were independent influencing factors for the prognosis of patients with septic shock,and the difference was statistically significant(P<0.05).The AUC of combined detection of PCT,cTnT,NT-proBNP,and D-D was higher than that of any index alone,and the difference was statistically significant(P<0.05).Conclusion:The levels of PCT,cTnT,NT-proBNP and D-D are closely related to the disease condition and prognosis of patients with septic shock,and the higher levels of the four indicators indicate the more serious disease condition,and the value of the combined detection of the four indicators for the prognosis assessment of patients with septic shock is higher.
作者
孔燕南
李侃力
汤志敏
王孔专
周君纯
Kong Yannan;Li Kanli;Tang Zhimin;Wang Kongzhuan;Zhou Junchun(Department of Clinical Laboratory,Fifth People's Hospital of Nanhai District,Foshan 528200,Guangdong Province,China;Department of Critical Care Medicine,Fifth People's Hospital of Nanhai District,Foshan 528200,Guangdong Province,China)
出处
《中国社区医师》
2023年第26期110-112,共3页
Chinese Community Doctors
