Abstract: Objective　To investigate the the correlation between plasma N-terminal pro-brain natriuretic peptide combined with hypersensitive troponin T and the prognosis of children with septic shock. Methods　The clinical data of 112 children with septic shock admitted to the Department of Pediatric Intensive Care Unit of  Children’s Hospital affiliated to Xi’an Jiaotong University from January 2018 to December 2020 were retrospectively analyzed. SPSS 20.0 statistical software was used for data analysis. Prognosis was used as the dependent variable， χ2 test was used for the constituent ratio of basic variables， binary Logistic regression was used to evaluate the prognosis of each variable， receiver operating characteristic curve （ROC） was used for specific prediction of variables with predictive value， and area under the curve （AUC） > 0.5 was used as predictive value. Results　A total of 112 children with septic shock were enrolled， and 55 of them died within 28 days， with a fatality rate of 49.1%. There were no significant differences between the survival group and the death group in gender， age， primary infection site， etiological characteristics or other baseline data （all P>0.05）. Compared with death group， there were no significant differences in leukocyte， blood glucose， procalcitonin， C-reactive protein or blood albumin in survival group （all P>0.05）. In the survival group， hemoglobin， platelet count， and left ventricular ejection fraction increased， but blood lactic acid， plasma natriuretic peptide precursor， high-sensitive troponin， creatine kinase isoenzyme， glutamate aminotran-sferase， aspartate aminotransferase， creatinine， blood urea nitrogen， prothrombin time， international normalized ratio， activated partial thrombin time， etc decreased， and the differences were statistically significant （all P<0.05）. Logistic regression analysis showed that blood lactic acid， plasma N-terminal pro-brain natriuretic peptide and hypersensitive troponin T were independent prognostic risk factors for septic shock in children.ROC curve analysis showed that blood lactic acid， plasma N-terminal pro-brain natriuretic peptide and hypersensitive troponin T all had predictive value for the prognosis of children with septic shock， and the area under the ROC curve （AUC） was 0.879， 0.930， and 0.703， respectively.The combination of the three had a sensitivity of 96.5%， a specificity of 85.5%， and an AUC of 0.96 in predicting the prognosis. Conclusion　Lactate， plasma N-terminal pro-brain natriuretic peptide，and hypersensitive troponin T are independent risk factors for children with septic shock， and the combination of the three has a good predictive value for the prognosis of children with septic shock.

Key words: plasma N-terminal pro-brain natriuretic peptide, hypersensitive troponin T, septic shock, child, risk factors for prognosis

摘要： 目的　探讨血浆脑利钠肽前体联合高敏肌钙蛋白T与脓毒性休克患儿预后的相关性。方法　回顾性分析2018年1月至2020年12月在西安交通大学附属儿童医院儿童重症医学科收治的112例脓毒性休克患儿的临床资料。数据分析采用SPSS20.0统计学软件，以预后为因变量，基础变量构成比采用χ2检验，采用二元Logistic回归对各变量进行预后评价，对具有预测价值的变量采用受试者工作特征曲线（ROC）进行特异性预测，以曲线下面积（AUC）>0.5为具有预测价值。结果　112例脓毒性休克患儿中28d死亡55例，病死率为49.1%。存活组与死亡组在性别、年龄、原发感染部位、病原学特征等基线资料方面，差异无统计学意义（均P>0.05）；与死亡组比较，存活组在白细胞、血糖、降钙素原、C反应蛋白、血白蛋白比较差异均无统计学意义（均P>0.05）；存活组在血红蛋白、血小板计数、左室射血分数增高，而在血乳酸、血浆脑利钠肽前体、高敏肌钙蛋白、肌酸激酶同工酶、谷氨酸氨基转移酶、天冬氨酸氨基转移酶、血肌酐、血尿素氮、凝血酶原时间、国际标准化比值、活化部分凝血活酶时间等方面降低，差异均具有统计学意义（均P<0.05）。Logistic回归分析显示血乳酸、血浆脑利钠肽前体、高敏肌钙蛋是儿童脓毒性休克预后的独立危险因素。ROC曲线分析显示血乳酸、血浆脑利钠肽前体、高敏肌钙蛋白均对脓毒症休克患儿预后有预测价值，AUC分别为0.879、0.930、0.703。三者联合预测预后的敏感度为96.5%，特异度为85.5%，AUC为0.96。结论　血乳酸、血浆脑利钠肽前体、高敏肌钙蛋白是影响脓毒症休克患儿的独立危险因素，三者联合对脓毒症休克患儿预后具有较好的预测价值。

关键词: 血浆脑利钠肽前体, 高敏肌钙蛋白T, 脓毒性休克, 儿童, 预后危险因素