脓毒症患儿急性期N末端脑钠肽前体与PCT、Hs-CRP的相关性研究

发布时间：2018-07-03 20:36

本文选题：脓毒症 + 血浆Nt-proBNP　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]本研究通过检测脓毒症患儿急性期血浆N末端脑钠肽前体(Nt-proBNP)、血清降钙素原(PCT)及超敏C反应蛋白(Hs-CRP)的水平,探讨血浆N末端脑钠肽前体(Nt-proBNP)对脓毒症早期预警的应用价值,为临床上脓毒症的早期诊断、评估其危重程度提供新的思路。[方法]采用前瞻性的研究方法,选取2015年9月至2016年10月在昆明医科大学附属第二医院儿科住院的患儿共111例,所有患儿按照感染的严重程度进行分组,分为脓毒症组患儿33例,一般感染组患儿49例,对照组(非感染组)患儿29例。于入院次日晨采空腹外周静脉血行血清PCT、Hs-CRP和血浆Nt-proBNP检测。血清PCT、Hs-CRP采用免疫荧光干式定量法测定,血浆Nt-proBNP采用电化学发光免疫双抗体夹心法测定。分析三组间Nt-proBNP、PCT、Hs-CRP的水平及相关性,绘制ROC曲线,明确检测最佳阈值。[结果]1.脓毒症组、一般感染组及对照组间性别、年龄比较:脓毒症组、一般感染组及对照组的年龄 M (P25, P75)分别为 3 (1.375,8.375)岁、3.917 (2.459,6.792)岁及8.000 (2.084,11.167)岁,三组比较X2为0.363, P=0.834,差异无统计学意义(P0.05)。性别(男%、女%)分别为(54.5%、45.5%)、(61.2%、38.8%)及(58.6%、41.4%),三组比较X2为5.245,P=0.73,差异无统计学意义(P0.05)。2.脓毒症组、一般感染组及对照组Nt-proBNP、PCT、Hs-CRP的比较:脓毒症组、一般感染组及对照组的Nt-proBNP分别为640.2 (444.35,3464.5) pg/ml、86.1 (36.9、254.95) pg/ml 及 62.9 (31.5,86.25) pg/ml,脓毒症组的 Nt-proBNP明显高于一般感染组及对照组,差异有统计学意义(P0.017); 一般感染组与对照组之间Nt-proBNP比较差异无统计学意义(P0.017)。同时发现脓毒症患儿PCT、Hs-CRP与一般感染组及对照组比较,差异有统计学意义(P0.05) 。3.严重脓毒症组、普通脓毒症组患儿Nt-proBNP、PCT、Hs-CRP的比较:严重脓毒症组、普通脓毒症组患儿的Nt-proBNP分别为4091 (2800,20594) pg/ml、548.2 (314.03,660.48) pg/ml,两组比较 z=-3.781,P=0.000,差异有统计学意义(P0.05);严重脓毒症组、普通脓毒症组患儿的PCT分别为8.25 (5.31,100)ng/ml、2.7 (0.28,4.51) ng/ml,两组比较 z=-3.171, P=0.002,差异有统计学意义(P0.05);严重脓毒症组、普通脓毒症组患儿Hs-CRP分别为45.98 (1.31,166)mg/1、33.99 (11.96,62.24) mg/1,两组比较 z=-0.38,P=0.97,差异无统计学意义(P0.05) 。4.严重脓毒症组、普通脓毒症组患儿Nt-proBNP、PCT及Hs-CRP的相关性分析:Nt-proBNP与PCT水平呈正相关(r=0.441,P=0.01);与Hs-CRP水平无相关关系(r=-0.7, P=0.669)。5.严重脓毒症组、普通脓毒症组患儿Nt-proBNP、PCT的ROC曲线:以Nt-proBNP、PCT分别为自变量进行ROC曲线的绘制,结果显示,Nt-proBNP与PCT的区域下面积、灵敏度、特异度分别为0.909、0.909、0.864和0.843、0.818、0.773,差异都有统计学意义(P0.05)。截点值分别为791.lpg/ml、4.755ng/ml。[结论]1.Nt-proBNP与PCT、Hs-CRP一样,可作为脓毒症的早期预警指标;2.脓毒症患儿急性期Nt-proBNP与PCT呈正相关,即PCT越高,Nt-proBNP越高,患儿病情越危重,提示Nt-proBNP水平可以较好的反映脓毒症患儿病情的危重程度;3.Nt-proBNP的区域下面积、灵敏度及特异度均高于PCT,说明Nt-proBNP在判断脓毒症患儿急性期病情的危重程度上更优于PCT。当Nt-proBNP大于791.lpg/ml,PCT大于4.755ng/ml时,患儿进展为重症脓毒症的可能性大。
[Abstract]:[Objective] to investigate the application value of N terminal brain natriuretic peptide precursor (Nt-proBNP) to early warning of sepsis by detecting the level of N terminal brain natriuretic peptide precursor (Nt-proBNP), serum calcitonin (PCT) and hypersensitivity C reactive protein (Hs-CRP) in acute stage of sepsis, and to evaluate the early diagnosis of sepsis in clinical and evaluate its critical degree. New ideas were provided. [method] a total of 111 children hospitalized in the Second Affiliated Hospital of Kunming Medical University from September 2015 to October 2016 were selected. All the children were divided into 33 cases in the sepsis group, 49 children in the same infection group, and 2 in the control group (non infected group). In the 9 case, serum PCT, Hs-CRP and plasma Nt-proBNP were detected in the venous blood of the abdominal peripheral vein on the next day of admission. Serum PCT, Hs-CRP was determined by immunofluorescence dry quantitative method, and plasma Nt-proBNP was determined by electrochemiluminescence immunization double antibody sandwich method. The level and correlation of Nt-proBNP, PCT, Hs-CRP in the three groups were analyzed, and ROC curves were plotted and detected clearly. [results]1. sepsis group, general infection group and control group, age comparison: age M (P25, P75) in sepsis group, general infection group and control group were 3 (1.375,8.375) years, 3.917 (2.459,6.792) and 8 (2.084,11.167) years, three groups were 0.363, P=0.834, the difference was not statistically significant (P0.05). (P0.05). Male and female%) were (54.5%, 45.5%), (61.2%, 38.8%) and (58.6%, 41.4%), the three groups were compared with X2 5.245, P=0.73, the difference was not statistically significant (P0.05).2. sepsis group, the general infection group and the control group Nt-proBNP, PCT, Hs-CRP: the sepsis group, the general infection group and the control group were 640.2 (444.353464.5) pg/ml, 86.1 (36.9,25). 4.95) pg/ml and 62.9 (31.5,86.25) pg/ml, the Nt-proBNP in the sepsis group was significantly higher than that of the general infection group and the control group. The difference was statistically significant (P0.017), and there was no statistical difference between the general infection group and the control group (P0.017). At the same time, the patients with sepsis were found to be PCT, and Hs-CRP was compared with the general infection group and the control group. The difference was statistically significant (P0.05).3. severe sepsis group, common sepsis group children Nt-proBNP, PCT, Hs-CRP: the Yan Zhongnong poison group, the common sepsis group of Nt-proBNP were 4091 (280020594) pg/ml, 548.2 (314.03660.48) pg/ml, two groups compared to z=-3.781, P=0.000, the difference was statistically significant (P0.05); severe sepsis Group PCT was 8.25 (5.31100) ng/ml, 2.7 (0.28,4.51) ng/ml, two group was z=-3.171, P=0.002, and the difference was statistically significant (P0.05). The Hs-CRP in the severe sepsis group and the common sepsis group were 45.98 (1.31166) mg/ 1,33.99 (11.96,62.24) mg/1, and the two groups were not statistically different. The correlation analysis of Nt-proBNP, PCT and Hs-CRP in patients with severe sepsis (P0.05).4. and common sepsis group: there was a positive correlation between Nt-proBNP and PCT level (r=0.441, P=0.01); there was no correlation with Hs-CRP level (r=-0.7, P=0.669). The variables were plotted with ROC curve. The results showed that the area of Nt-proBNP and PCT were 0.909,0.909,0.864 and 0.843,0.818,0.773 respectively. The difference was statistically significant (P0.05). The cut points were 791.lpg/ml respectively. 4.755ng/ml.[conclusion]1.Nt-proBNP and PCT, Hs-CRP, can be used as early warning indicators for sepsis; 2 There was a positive correlation between Nt-proBNP and PCT in children with sepsis at acute stage, that is, the higher the PCT, the higher the Nt-proBNP, the more critical the condition of the children, suggesting that the level of Nt-proBNP can better reflect the critical degree of the patients with sepsis; the area of the 3.Nt-proBNP area, the sensitivity and the specificity are higher than that of the PCT, indicating that Nt-proBNP is in the judgement of acute phase disease in children with sepsis. The degree of crisis is better than that of PCT.. When Nt-proBNP is greater than 791.lpg/ml and PCT is greater than 4.755ng/ml, the possibility of progression to severe sepsis is high.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R720.597

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