摘要
目的分析革兰阴性杆菌感染脓毒症患者B型利钠肽(BNP)水平与血流动力学参数及炎性因子之间的相关性,以判断BNP水平显著升高的主要危险因素。方法采用前瞻研究方法,选择2017年5月至2019年10月收治的革兰阴性杆菌感染的脓毒症患者。以BNP平均值为分界线将患者分为BNP<2400 ng/L组和BNP≥2400 ng/L组,采用多因素Logistic回归分析其独立预测因子;采用Pearson相关分析BNP与各指标的相关性。结果共纳入106例革兰阴性杆菌感染的脓毒症患者。血清BNP平均(2398.45±421.45)ng/L,其中高于平均值有60例,把BNP≥2400 ng/L判定为显著增高。多元Logistic回归分析显示,心脏指数(CI)[优势比(OR)=0.428,95%可信区间(95%CI)=0.743~0.965,P=0.011]、左心射血分数(LVEF)(OR=0.394,95%CI=0.182~0.549,P=0.013)、乳酸(OR=1.983,95%CI=1.264~3.420,P=0.023)、内毒素(OR=6.146,95%CI=4.091~8.226,P=0.001)、降钙素原(PCT)(OR=6.513,95%CI=4.365~8.210,P=0.005)、心肌钙蛋白I(cTnI)(OR=1.144,95%CI=1.001~2.150,P=0.047)是革兰阴性杆菌感染脓毒症患者BNP≥2400 ng/L的独立预测因子。Pearson相关性分析显示,BNP与CI(R=-0.514,P<0.001)、LVEF(R=-0.552,P<0.001)呈负相关,与乳酸(R=0.265,P=0.032)、cTnI(R=0.204,P=0.036)、PCT(R=0.801,P<0.001)、内毒素(R=0.765,P<0.001)呈正相关。结论LVEF、CI、乳酸、cTnI、内毒素和PCT是革兰阴性杆菌脓毒症患者BNP显著升高的独立危险因素,但其中PCT和内毒素与BNP升高更为相关。内毒素及炎症反应很可能是革兰阴性杆菌脓毒症患者BNP明显升高的更重要刺激因子。
Objective To study the correlation of B-type natriuretic peptide(BNP)level with hemodynamic parameters and inflammatory cytokines in patients with Gram-negative sepsis,and further determine the main factors for the significant increase of BNP level.Methods The prospective study method was applied,and septic patients infected with Gram-negative bacteria from May 2017 to October 2019 were enrolled.The patients were divided into the BNP<2400 ng/L group and the BNP≥2400 ng/L group by taking the average value of BNP as the dividing point.The independent predictors of BNP≥2400 ng/L were analyzed by Logistic regression.Pearson correlation analysis was used to analyze the correlation between BNP and various indicators.Results A total of 106 patients with Gram-negative sepsis were included,among which 60 cases present with higher serum BNP levels than the average of(2398.45±421.45)ng/L.Thus BNP≥2400 ng/L was considered as a significantly increased BNP level.Multiple logistic regression analysis showed that cardiac index(CI)[odds ratio(OR)=0.428,95%confidence interval(95%CI)=0.743-0.965,P=0.011],left ventricular ejection fraction(LVEF)(OR=0.394,95%CI=0.182-0.549,P=0.013),lactic acid(OR=1.983,95%CI=1.264-3.420,P=0.023),endotoxin(OR=6.146,95%CI=4.091-8.226,P=0.001),procalcitonin(PCT)(OR=6.513,95%CI=4.365-8.210,P=0.005)and cardiac troponin I(cTnI)(OR=1.144,95%CI=1.001-2.150,P=0.047)were independent predictors of BNP≥2400 ng/L in patients with Gram-negative sepsis.Pearson correlation analysis showed that BNP was negatively correlated with CI(R=-0.514,P<0.001)and LVEF(R=-0.552,P<0.001),whereas positively correlated with lactic acid(R=0.265,P=0.032),cTnI(R=0.204,P=0.036),PCT(R=0.801,P<0.001),and endotoxin(R=0.765,P<0.001).Conclusions In septic patients with Gram-negative bacterial infection,LVEF,CI,lactic acid,cTnI,endotoxin and PCT are all independent risk factors for the significant increase of BNP,and endotoxin and PCT were more significantly correlated with BNP increase.Endotoxin and inflammatory reaction may be the more important stimulators of BNP increase in septic patients with Gram-negative bacterial infection.
作者
黄浩
陈湘平
李程锦
陈凤朱
林立伟
张金炎
滕真真
赵白荧
HUANG Hao;CHEN Xiangping;LI Chengjin;CHEN Fengzhu;LIN Liwei;ZHANG Jinyan;TENG Zhenzhen;ZHAO Baiying(Department of Intensive Care Unit,Fujian Provincial Hospital North Branch,Fujian Provincial Geriatric Hospital,Fuzhou 350003,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2021年第6期879-885,共7页
Acta Academiae Medicinae Sinicae
基金
福建省医药卫生科研人才培养项目(2017-411)。
关键词
革兰阴性杆菌
脓毒症
B型利钠肽
心功能
炎症因子
Gram-negative bacteria
sepsis
B-type natriuretic peptide
cardiac function
inflammatory cytokines
