目的 探讨N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）联合下腔静脉变异度（inferior vena cava variability,IVC-RVI）在脓毒症休克患者容量反应性与预后中的动态评估价值。方法 回顾性分析无锡市中医医院急诊科的50例脓毒症休克患者。对所有患者给予液体容量复苏治疗,根据治疗后是否出现容量反应性,将患者分为容量有反应组（38例）和容量无反应组（12例）;根据28 d后的病情转归分为生存组（34例）和死亡组（16例）。检测患者治疗前和治疗后24、72 h的NT-proBNP、IVC-RVI水平;绘制ROC曲线分析NT-proBNP、IVC-RVI对脓毒症休克患者容量反应性和临床预后的动态诊断价值。结果 与容量无反应组相比,容量有反应组治疗前的NT-proBNP水平较低、IVC-RVI水平较高,治疗前NT-proBNP和IVC-RVI联合检测对脓毒症休克患者容量反应性的诊断价值（AUC=0.798）优于单一的NT-proBNP（AUC=0.765）和IVC-RVI（AUC=0.770）;与死亡组相比,生存组治疗前、治疗后24 h、后72 h的NT-proBNP水平较低、IVC-RVI水平较高,治疗前和治疗后24、72 h的NT-proBNP和IVC-RVI联合检测对脓毒症休克患者临床预后的诊断价值优于单一指标,其中治疗后72 h联合检测的诊断价值最高（AUC=0.972）。结论 NT-proBNP低水平与IVC-RVI高水平是脓毒症休克患者容量反应良好与预后改善的特征,其联合应用可提升评估效能。
Abstract
Objective To investigate the dynamic assessment value of N-terminal pro-brain natriuretic peptide (NT-proBNP) combined with inferior vena cava variability (IVC-RVI) for volume responsiveness and prognosis in patients with septic shock. Methods A retrospective analysis of 50 patients with septic shock admitted to the Department of Emergency, Wuxi Hospital of Traditional Chinese Medicine. All patients were treated with fluid resuscitation and divided into volume-responsive group (38 cases) and non-responsive group (12 cases) based on their volume responsiveness after treatment; and into survival group (34 cases) and death group (16 cases) based on their clinical outcomes after 28 days. Levels of NT-proBNP and IVC-RVI were measured before treatment and at 24 h and 72 h post-treatment; ROC curves were plotted to analyze the dynamic diagnostic value of NT-proBNP and IVC-RVI in volume responsiveness and clinical prognosis in patients with septic shock. Results Compared with the non-responsive group, the volume-responsive group had lower NT-proBNP levels and higher IVC-RVI levels before treatment, and the combined detection of NT-proBNP and IVC-RVI before treatment had a higher diagnostic value for volume responsiveness (AUC=0.798) than single indicators NT-proBNP (AUC=0.765) and IVC-RVI (AUC=0.770); Compared with the death group, the survival group had lower NT-proBNP levels and higher IVC-RVI levels before treatment and at 24 h and 72 h post-treatment, and the combined detection of NT-proBNP and IVC-RVI before treatment and at 24 h and 72 h post-treatment had a higher diagnostic value for clinical prognosis than single indicators, with the highest diagnostic value at 72 h post-treatment (AUC=0.972). Conclusion Low levels of NT-proBNP coupled with elevated IVC-RVI characterize septic shock patients with favorable volume responsiveness and improved clinical outcomes, while their integrated application demonstrates superior diagnostic performance.
关键词
N末端脑钠肽前体 /
下腔静脉变异度 /
脓毒症休克 /
容量反应性
Key words
N-terminal pro-brain natriuretic peptide /
inferior vena cava variability /
septic shock /
volume responsiveness
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基金
无锡市中医药管理局科技项目“大黄牡丹汤对脓毒症患者肠道菌群调节作用的初步机制研究”（ZYKJ202109）; 无锡市卫健委适宜技术推广项目“B超引导下颈外静脉通路负压穿刺技术在急诊休克患者中的推广应用”（T202041）
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