中性粒细胞明胶酶相关脂质运载蛋白、N末端脑钠肽前体对烧伤脓毒症的预测价值

The value of NGAL and NT-proBNP for predicting sepsis in burn patients

摘要:

目的 研究中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、N末端脑钠肽前体（NT-proBNP）在烧伤脓毒症中的预测价值。方法 回顾性分析2023年1月—2025年1月南京医科大学附属淮安第一医院收治的63例烧伤面积≥20%烧伤患者的临床资料，依据是否合并脓毒症分为脓毒症组（33例）和非脓毒症组（30例）。比较两组患者的一般情况、烧伤情况及预后，并比较两组烧伤后第1和3天白细胞（WBC）、中性粒细胞（N）、血小板（PLT）、平均血小板体积（MPV）、降钙素原（PCT）、NGAL、NT-proBNP水平。选取差异有统计学意义的指标绘制受试者工作特征（ROC）曲线，评估上述指标在大面积烧伤患者早期脓毒症中的预测价值。结果 脓毒症组烧伤面积、合并吸入性损伤率和住院时间均高于非脓毒症组（P <0.05），治愈率低于非脓毒症组（P <0.05）。第1天脓毒症组WBC、N、MPV、PCT、NGAL和NT-proBNP水平均高于非脓毒症组（P <0.05）。第3天脓毒症组MPV、PCT、NGAL和NT-proBNP水平均高于非脓毒症组（P <0.05），PLT水平低于非脓毒症组（P <0.05）。ROC曲线结果显示，烧伤后第1天NT-proBNP、PCT、NGAL预测脓毒症的敏感性分别为60.6%、87.9%、87.9%，特异性分别为86.7%、56.7%、53.3%，曲线下面积（AUC）分别为0.805、0.780、0.742；烧伤后第3天NT-proBNP、PCT、NGAL预测烧伤脓毒症的敏感性分别为84.9%、81.8%、87.8%，特异性分别为70.0%、76.7%、46.7%，AUC分别为0.873、0.835、0.719。结论 NT-proBNP、PCT、NGAL对烧伤脓毒症的早期诊断具有较高的临床价值，其中NGAL预测脓毒症的敏感性更高，NT-proBNP的特异性更高。

Abstract:

Objective To study the predictive value of neutrophil gelatinase-associated lipocalin (NGAL) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for sepsis in burn patients.Methods This study retrospectively analyzed the clinical data of 63 burn patients with burns covering more than 20% of body surface area admitted to our hospital from January 2023 to January 2025. The patients were divided into the sepsis group (33 cases) and the non-sepsis group (30 cases) based on the presence of sepsis. The general conditions, burn characteristics, and prognosis of the two groups were compared. Levels of white blood cells (WBC), neutrophils (N), platelets (PLT), mean platelet volume (MPV), procalcitonin (PCT), NGAL, and NT-proBNP were measured on days 1 and 3 after burn injury and compared between the two groups. Indicators showing statistically significant differences were subjected to receiver operating characteristic (ROC) curve analysis to evaluate their diagnostic value for early sepsis in patients with extensive burns.Results The burn area, incidence of inhalation injury, and length of hospital stay were significantly higher in the sepsis group than in the non-sepsis group (P < 0.05), whereas the cure rate was significantly lower in the sepsis group (P < 0.05). On day 1 after burn injury, levels of WBC, N, MPV, PCT, NGAL, and NT-proBNP were all significantly higher in the sepsis group compared with the non-sepsis group (P < 0.05). On day 3, levels of MPV, PCT, NGAL, and NT-proBNP remained significantly higher in the sepsis group (P < 0.05), while PLT levels were significantly lower (P < 0.05). ROC curve analysis showed that, on day 1 after burn injury, the sensitivities of NT-proBNP, PCT, and NGAL for predicting sepsis were 60.6%, 87.9%, and 87.9%, with specificities of 86.7%, 56.7%, and 53.3%, and areas under the curve (AUCs) of 0.805, 0.780, and 0.742, respectively. On day 3, the sensitivities of NT-proBNP, PCT, and NGAL for predicting burn-related sepsis were 84.9%, 81.8%, and 87.8%, with specificities of 70.0%, 76.7%, and 46.7%, and AUCs of 0.873, 0.835, and 0.719, respectively.Conclusion NT-proBNP, PCT, and NGAL show high clinical value for the early diagnosis of burn-related sepsis, with NGAL demonstrating higher sensitivity and NT-proBNP exhibiting greater specificity.