Evaluation Of N-Terminal Pro B Type Natriuretic Peptide For Cardiac Function In Patient With Severe Sepsis And Clinic Research Of Ulinastatin

BACKGROUND: Sepsis is defined as infection caused body’ssystemic inflammatory response syndrome (SIRS).Severe sepsis ariseswhen it combinated with acute dysfunction of one or more vital organs,itwas one of the main reanson caused patient dead in ICU. Myocardial injuryand dysfunction are existed in patients with sepsis, they are also the mainreason caused elevation of plasma BNP. Ulinastatin is a kind of inhibitor ofproteinase, it plays an important role of inhibiting prolease and inflamatorycytokine, stabilizing lysosomal membrane, it was widely used in therapy ofacute pancreatitis, acute lung injury/acute respiratory distress syndrome andsepsis.Objective: We investigated the correlation between Nt-pro BNP, LVEFand inflammatory cytokines(IL-1, IL-6, TNF-a), determined the predictivevalue and prognosis in severe sepsis patients with early myocardialdysfunction，identified the interference effect of ulinastatin in sepsisinduced myocardial dysfunction. Metheod: Forty severe sepsis patients who according with diagnosticcode of2001International Sepsis Definitions Conference, were randomlydivided into control group (group C) and ulinastatin group (group U), with20patients in each group. Group C accepted therapy includeanti-infection,circulation support(fluid resuscitation, vasoactive agent),respiratory support(oxygen, mechanical ventilation), glucose control,prevent deep vein thrombus and stress ulcer. Group U accepted additionaltherapy of ulinastatin intravenous drop,300,000units each time,two timesa day for5days, then reduced to100,000units each time, two times a dayfor2days. Concentration of plasma Nt-pro BNP, IL-1, IL-6, TNF-a andleft ventricular ejection fraction were measured at pre-therapy, the4thdayand the7thday.Result: There was no difference of clinical characters such as age,gender, APACHEⅡscore and renal function between two groups.Concentration of plasma Nt-pro BNP reach peak on the4thday, group Uwas lower than group C, then reduced on the7thday, which lower thanpretherapy in two groups,but the difference had statistical significance onlyin group U(p<0.05). The level of LVEF was lowest on the4thday in twogroups, it was lower in group C than in group U, then it elevated on the7thday, higher in group U(p<0.05). All patients was divided into two groupsaccording to LVEF, LVEF>50%was normal cardial function, the other wasabnormal. Concentration of plasma Nt-pro BNP was higher in group abnormal(p<0.05). Concentration of plasma cytokines(IL-1, IL-6, TNF-a)reach peak pretherapy in two groups, then reduced gradually, it was loweston the7thday and lower than pretherapy in group U(P<0.05).Theconcentration was lower in group U. There was negative correlationbetween Nt-pro BNP and LVEF, positive correlation between Nt-pro BNPand cytokines(IL-1, IL-6, TNF-a). The concentration of Nt-pro BNP washigher in dead group than in survival group, the difference on7thday hadstatistical significance(P<0.05).Conclusion: Concentration of Nt-pro BNP positively correlated withcytokines(IL-1, IL-6, TNF-a), the correlations confirmed that cytokineswas the possible mechanism of SIMD; it negatively correlated with LVEF,it maybe can be used to prognosis myocardial function in patients withsevere sepsis and the concentration of Nt-pro BNP on7thday maybecorrelated with prognosis; ulinastatin can reduce concentration of Nt-proBNP and cytokines(IL-1, IL-6, TNF-a), improve myocardial function ofsevere sepsis patients.