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目的探讨前心房利钠肽(pro-ANP)在脓毒症早期特异性诊断中的临床价值。方法前瞻性地将2007年6月至11月上海交通大学附属第一人民医院综合重症加强治疗病房(ICU)51例危重病患者按国际脓毒症标准分为全身性炎症反应综合征(SIRS,25例)、脓毒症(12例)、严重脓毒症(9例)、脓毒症性休克(5例)4组,53名年龄相匹配的健康个体作为对照组,采用新型夹心免疫荧光法检测各组患者中血pro-ANP浓度并和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、降钙素原(PCT)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)等比较。结果SIRS组、脓毒症、严重脓毒症和脓毒症性休克组,血浆pro-ANP浓度逐渐升高(分别为87.22、533.30、1098.73和1933.94μg/L),差异有统计学意义(P<0.05)。在脓毒症组中,与其他标志物相比,死亡患者的pro-ANP浓度比存活患者明显升高,差异有统计学意义(P<0.05),在住院第1天差异即非常明显(P<0.05)。在脓毒症患者的受试者工作曲线分析中,pro-ANP和PCT、APACHEⅡ评分的曲线下面积相同,明显高于CRP和IL-6。结论pro-ANP浓度测定对脓毒症早期特异性诊断和严重程度评估有极大的临床价值。
Objective To investigate the clinical value of pro-ANP in the early diagnosis of sepsis. Methods A total of 51 critically ill patients admitted to the First People’s Hospital Affiliated to Shanghai Jiaotong University from June 2007 to November 2007 were divided into three groups according to international sepsis criteria: systemic inflammatory response syndrome (SIRS, (N = 25), sepsis (n = 12), severe sepsis (n = 9), septic shock (n = 4) and 53 age-matched healthy individuals served as control group. Methods The levels of serum pro-ANP in each group were measured and compared with the scores of APACHEⅡ, PCT, CRP and IL-6 in acute physiology and chronic health condition, -6) and so on. Results In the SIRS group, the levels of pro-ANP in plasma, plasma sepsis, severe sepsis and septic shock increased gradually (87.22,533.30,1098.73 and 1933.94μg / L, respectively), the difference was statistically significant (P <0.05). In the sepsis group, the pro-ANP concentration of death patients was significantly higher than that of other patients in the sepsis group (P <0.05), and the difference was significant on the first day of hospitalization (P <0.05). In the working curve analysis of subjects with sepsis, the area under the curve of pro-ANP and PCT, APACHE II score was the same, significantly higher than that of CRP and IL-6. Conclusion The determination of pro-ANP concentration has great clinical value in the early diagnosis and severity of sepsis.