B型钠尿肽可用于预测感染性休克
据3月24日健康革命网站报道，美国研究者发现B型钠尿肽（BNP）是无充血性心衰感染性休克患者诊断和危险性分层的有用生物标记。
目前，美国每年大概20万例脓毒血症致死性病例，主要由心血管疾病引发。研究人员在3月发行的《手术档案》杂志上发文表示，脓毒血症的发病能导致心肌细胞损伤和心脏收缩性功能残缺。
美国纽约州立大学唐斯•泰特医学中心马丁•布鲁斯博士以及同事研究认为，有必要通过一种简单可靠的方法来判断感染性休克患者的心血管功能残缺。布鲁斯认为，虽然其他研究已经显示BNP可作为脓毒血症和心脏疾病的一种标记物，但这次是首次将BNP作为单纯脓毒血症潜在标记物应用到试验中，并且将患有任何心脏疾病的患者排除在该项研究之外。
研究小组把病人分成组，并将各组病例间的BNP水平进行比较。试验中共有13例感染性休克患者，并且所有的感染性休克患者没有心脏衰竭或肾脏衰竭，还有18例早期脓毒血症患者，同时还加入了与患者年龄相似的18例健康人作为比对。在随访的第21天，研究小组利用SOFA评分系统评价脓毒血症的严重程度。研究人员发现，与正常人的那一组比较，非早期脓毒血症的感染性休克患者的BNP水平升高(p<0.05)。此外，发现BNP水平与SOFA积分直接相关。而在感染性休克的患者中，BNP水平下降能预测生存率，而持续的BNP高水平则与死亡相关。
但是，也有科学家质疑患者BNP水平可预测感染性休克的结论。他们认为，研究人员并没有提供数据支持他们的提法。因此，布鲁斯强调，这项研究还只是初步探讨，在BNP在脓毒血症中的作用和应用确证之前，还需要进一步的研究。
生物谷推荐原始出处：
（Archives of Surgery），2008;143(3):242-246，Emad Kandil, Martin H. Bluth
A Biomarker for the Diagnosis and Risk Stratification of Patients With Septic Shock
Emad Kandil, MD; Joshua Burack, MD; Ahmed Sawas, MD; Haidy Bibawy, MD; Alex Schwartzman, MD; Michael E. Zenilman, MD; Martin H. Bluth, MD, PhD
Arch Surg. 2008;143(3):242-246.
Background The importance of cardiomyocyte damage during sepsis has been a recent subject of interest. The progression of sepsis results in the upregulation of proinflammatory cytokines, which act in concert to damage cardiomyocytes and produce cardiac contractile dysfunction. B-type natriuretic peptide (BNP) is a neurohormone released from the ventricles of the heart in response to myocardial dysfunction. The goal of this study was to examine the relationship between BNP levels and the severity of sepsis independent of congestive heart failure.
Design Prospective, nonrandomized control study.
Setting University hospital.
Patients Forty-nine patients were divided into 3 groups: 13 patients with septic shock, 18 with early sepsis, and 18 age-matched healthy control subjects. We excluded patients with septic shock who had comorbid conditions (congestive heart failure or renal failure); sepsis severity was determined using the Sequential Organ Failure Assessment scoring system. Patients with sepsis were followed up for 21 days.
Main Outcome Measures Serum BNP levels, determined at the time of diagnosis of sepsis and on patient improvement or deterioration.
Results Patients with septic shock had significantly higher BNP levels on admission compared with the other 2 groups (P < .05). The BNP levels were not significantly elevated in patients with early sepsis. Plasma BNP levels for patients with septic shock were positively correlated with Sequential Organ Failure Assessment scores (r2 = 0.74, P < .05) and prognosticated survival.
Conclusions This study confirms the relationship between BNP level elevation and severity of sepsis independent of congestive heart failure. It also supports the utility of BNP level as a marker for mortality in septic shock.
- 众说风云 (已有0条评论)
