肌钙蛋白I、B型脑钠肽对脓毒症性心肌功能障碍发生的预测与预后评估价值
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摘要
目的探讨肌钙蛋白I(c Tn I)、B型脑钠肽(BNP)在脓毒症性心肌功能障碍患者中预测发生和评估预后的价值。方法将76例脓毒症患者根据左心室射血分数是否<50%,分为心肌功能障碍组和心功能正常组;并根据28 d是否存活将心肌功能障碍组分为存活亚组和死亡亚组,利用受试者工作者特征(ROC)曲线观察入ICU 1 h、24 h的c Tn I、BNP预测心肌功能障碍发生以及预后评估意义。结果心肌功能障碍组的1 h c Tn I、24 h c Tn I、1 h BNP、24 h BNP均高于心功能正常组,差异有统计学意义(均P<0.05)。1 h c Tn I、24 h c Tn I、1 h BNP、24 h BNP预测脓毒症心肌功能障碍发生的曲线下面积分别为0.78、0.72、0.73、0.76,敏感性与特异性均较高,其中1 h c Tn I预测效能最高,界值为0.73 ng/ml,敏感性为0.71,特异性为0.74。1 h c Tn I、24 h c Tn I、1 h BNP、24 h BNP评估脓毒症心肌功能障碍患者28 d死亡的曲线下面积分别为0.81、0.87、0.86、0.90,特异性、敏感性均较高。其中24 h BNP评估28 d死亡的效能最高,界值为2 000 pg/ml,敏感性为0.85,特异性为0.83。结论脓毒症时早期监测BNP、c Tn I水平可预测心肌功能障碍发生,并有利于判断预后。
Objective To evaluate the predictable and prognostic value of cardiac troponin I and brain natriuretic peptide in patients with sepsis-associated myocardial dysfunction(SMD). Methods 76 patients with sepsis were divided into the SMD group and the normal cardiac function group in relation to left ventricle ejection fraction(<50%). Moreover patients with SMD were divided into death subgroup and survival subgroup according to 28-day mortality. Receiver operating characteristic curve(ROC) was constructed to observe the predictable and prognostic value of c Tn I and BNP on the first 1 hour and 24 hour after ICU admission. Results The levels of the 1 h-c Tn I, 24 h-c Tn I, 1 h-BNP and 24 h-BNP in SMD group were significantly higher than them in normal cardiac function group(all P<0.05). The area under the curve of 1 h-c Tn I, 24 h-c Tn I, 1 h-BNP and 24 h-BNP were 0.78, 0.72, 0.73, 0.76 respectively in predicting the occurrence of SMD with high sensibility and specificity. With a cutoff value of 0.73 ng/ml, 1 h-c Tn I was the best marker to predict SMD occurrence(sensibility=71%, specificity=74%). The area under the curve(AUC) of 1 h-c Tn I, 24 h-c Tn I, 1 h-BNP and 24 h-BNP were 0.81, 0.87, 0.86, 0.90 respectively in predicting 28-day mortality, with high sensibility and specificity. With a cutoff value of 2 000 pg/ml, 24 h-BNP was the best marker to predict 28-day mortality(sensibility=71%, specificity=74%). Conclusion Early detection of BNP and c Tn I levels may help to early predict myocardial dysfunction in patients with sepsis and evaluate their prognoses.
Objective To evaluate the predictable and prognostic value of cardiac troponin I and brain natriuretic peptide in patients with sepsis-associated myocardial dysfunction(SMD). Methods 76 patients with sepsis were divided into the SMD group and the normal cardiac function group in relation to left ventricle ejection fraction(<50%). Moreover patients with SMD were divided into death subgroup and survival subgroup according to 28-day mortality. Receiver operating characteristic curve(ROC) was constructed to observe the predictable and prognostic value of c Tn I and BNP on the first 1 hour and 24 hour after ICU admission. Results The levels of the 1 h-c Tn I, 24 h-c Tn I, 1 h-BNP and 24 h-BNP in SMD group were significantly higher than them in normal cardiac function group(all P<0.05). The area under the curve of 1 h-c Tn I, 24 h-c Tn I, 1 h-BNP and 24 h-BNP were 0.78, 0.72, 0.73, 0.76 respectively in predicting the occurrence of SMD with high sensibility and specificity. With a cutoff value of 0.73 ng/ml, 1 h-c Tn I was the best marker to predict SMD occurrence(sensibility=71%, specificity=74%). The area under the curve(AUC) of 1 h-c Tn I, 24 h-c Tn I, 1 h-BNP and 24 h-BNP were 0.81, 0.87, 0.86, 0.90 respectively in predicting 28-day mortality, with high sensibility and specificity. With a cutoff value of 2 000 pg/ml, 24 h-BNP was the best marker to predict 28-day mortality(sensibility=71%, specificity=74%). Conclusion Early detection of BNP and c Tn I levels may help to early predict myocardial dysfunction in patients with sepsis and evaluate their prognoses.
引文
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[11]Zanotti-Cavazzoni SL,Hollenberg SM.Cardiac dysfunction in severe sepsis and septic shock[J].Curr Opin Crit Care,2009,15(5):392-397.
[12]Klouche K,Pommet S,Amigues L,et al.Plasma brain natriuretic peptide and troponin levels in severe sepsis and septic shock:relationships with systolic myocardial dysfunction and intensive care unit mortality[J].J Intensive Care Med,2013,29(4):229-237.
[13]Brueckmann M,Huhle G,Lang S,et al.Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis[J].Circulation,2005,112(4):527-534.
[14]李振华,董磊,王国兴,等.脑利钠肽、肌钙蛋白T和I监测对重症脓毒症和脓毒症休克预后的意义[J].中华急诊医学杂志,2012,21(9):1016-1021.
[15]郭少卿,邹原方.降钙素原和N末端前体脑钠肽对脓毒血症预后评估意义的研究[J/CD].中华临床医师杂志:电子版,2014,8(10):1859-1861.
[2]Charpentier J,Luyt CE,Fulla Y,et al.Brain natriuretic peptide:A marker of myocardial dysfunction and prognosis during severe sepsis[J].Crit Care Med,2004,32(3):660-665.
[3]Ver EK,Spapen HD,Nguyen DN,et al.Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock[J].Clin Chem,2000,46(5):650-657.
[4]Bessiere F,Khenifer S,Dubourg J,et al.Prognostic value of troponins in sepsis:a meta-analysis[J].Intensive Care Med,2013,39(7):1181-1189.
[5]Post F,Weilemann LS,Messow CM,et al.B-type natriuretic peptide as a marker for sepsis-induced myocardial depression in intensive care patients[J].Crit Care Med,2008,36(11):3030-3037.
[6]Bouhemad B,Nicolas-Robin A,Arbelot C,et al.Acute left ventricular dilatation and shock-induced myocardial dysfunction[J].Crit Care Med,2009,37(2):441-447.
[7]Dellinger RP,Levy MM,Rhodes A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[8]Zaky A,Deem S,Bendjelid K,et al.Characterization of cardiac dysfunction in sepsis:an ongoing challenge[J].Shock,2014,41(1):12-24.
[9]Landesberg G,Gilon D,Meroz Y,et al.Diastolic dysfunction and mortality in severe sepsis and septic shock[J].Eur Heart J,2012,33(7):895-903.
[10]Parrillo JE,Burch C,Shelhamer JH,et al.A circulating myocardial depressant substance in humans with septic shock.Septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance[J].J Clin Invest,1985,76(4):1539-1553.
[11]Zanotti-Cavazzoni SL,Hollenberg SM.Cardiac dysfunction in severe sepsis and septic shock[J].Curr Opin Crit Care,2009,15(5):392-397.
[12]Klouche K,Pommet S,Amigues L,et al.Plasma brain natriuretic peptide and troponin levels in severe sepsis and septic shock:relationships with systolic myocardial dysfunction and intensive care unit mortality[J].J Intensive Care Med,2013,29(4):229-237.
[13]Brueckmann M,Huhle G,Lang S,et al.Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis[J].Circulation,2005,112(4):527-534.
[14]李振华,董磊,王国兴,等.脑利钠肽、肌钙蛋白T和I监测对重症脓毒症和脓毒症休克预后的意义[J].中华急诊医学杂志,2012,21(9):1016-1021.
[15]郭少卿,邹原方.降钙素原和N末端前体脑钠肽对脓毒血症预后评估意义的研究[J/CD].中华临床医师杂志:电子版,2014,8(10):1859-1861.