巨噬细胞移动抑制因子对严重脓毒症心肌抑制的预测价值  

Predictive value of macrophage migration inhibitory factor in the diagnosis of myocardial depression induced by severe sepsis

作　　者：李真玉[1] 胡轶鹏[1] 梁丽娜[1] 胡慧卿[1] 陈兵[1] 

机构地区：[1]天津医科大学第二医院急诊科,天津300211

出　　处：《中国急救医学》2014年第7期581-585,共5页Chinese Journal of Critical Care Medicine

基　　金：天津医科大学第二医院科研基金项目（y1103）

摘　　要：目的探讨巨噬细胞移动抑制因子（MIF）对严重脓毒症患者心肌抑制的预测价值。方法采用前瞻性研究方法，于2011—12～2013—06对本院ICU符合严重脓毒症诊断标准的42例患者进行研究，入住当日根据血流动力学分为两组，心脏指数（CI）〈3L／（min·m^2）并全心舒张末期容积指数（GEDVI）〉800mL／m^2为心肌抑制组，其余为非抑制组。入住第1、3、513收集血流动力学指标及血清MIF、B型钠尿肽（BNP）、肌钙蛋白I（cTnI）水平。结果①第1日心肌抑制组的血流动力学参数、CI、每搏量容积（SV）、全心射血分数（GEF）、左心室收缩力指数（dpmax）低于非抑制组（P〈0．05）；②心肌抑制组3次MIF与CI均具有显著负相关性，3次MIF与BNP均具有显著正相关性（P〈0．01）；③第1日MIF诊断脓毒症心肌抑制的ROC曲线下面积（AUC）为0．957，以5．645pg／mL为截断点，其预测心肌抑制的敏感度为90％，特异度为100％，MIF与BNP预测价值相同；④心肌抑制组3次MIF、BNP均显著高于非抑制组（P〈0．01），两组MIF均动态下降（P〈0．05），心肌抑制组BNP动态下降（P〈0．05）；第1、3日心肌抑制组cTnI均显著高于非抑制组（P〈0．01），心肌抑制组cTnI动态下降（P〈0．05）；心肌抑制组3次CI均显著低于非抑制组（P〈0．01），两组cI呈上升趋势，但差异均无统计学意义（P〉0．05）。结论严重脓毒症患者存在心功能不全，MIF作为心肌抑制因子对脓毒症心肌抑制有预测作用。Objective To evaluate the predictive value of macrophage migration inhibitory factor （MIF） in the diagnosis of myocardial depression induced by severe sepsis and septic shock. Methods Forty - two severe septic patients were enrolled between December 2011 and June 2013. The patients were monitored by PiCCO system and divided into two groups according to the hemodynamic parameters： myocardial depression group： cardiac index （CI） 〈 3 L/（ min·m2） and global end diastolic volume index （GEDVI） 〉 800 mL/m2; the remaining patients were in non -suppression group. Hemodynamic parameters and serum MIF, B -type natriuretic peptide （BNP）, cardiac troponin I （cTnI） levels on days 1,3, 5 after admission were collected. Results （1）The hemodynamic parameters CI, stroke volume （SV） , global ejection fraction （GEF） , left ventricular contractility index （dpmax） in myocardial depression group were lower than those in non - suppression group on day 1 （P 〈 0.05 ） ; and serum values of MIF, BNP and cTnI in myocardial depression group were higher than those in non - suppression group （ P 〈 0.01 ） ; （2）MIF negatively correlated with CI, and positively correlated with BNP in myocardial depression group （ P 〈 0.01 ） ; （3）The area under the ROC curve （ AUC ） for MIF was 0. 957, with a sensitivity of 90% and a specificity of 100 % when cut - off point was 5. 645 pg/mL, the power of predicting septic myocardial suppression for MIF was equal to that of BNP; （4）The levels of serum MIF, BNP in myocardial depression group were higher than those in non - depression group, and decreased towards normal level in suppression group （P 〈 0. 05） ; there was an increasing trend for CI in two group% but there was no statistical difference （P 〉 0.05）. Conclusion Myocardial dysfunction is common m severe sepsis and septic shock patients, MIF as a myocardial depressant factor plays an important role in predicting myocardial suppression.

关 键 词：严重脓毒症 心功能不全 B型钠尿肽(BNP) 心肌抑制(SIMD) 巨噬细胞移动抑制因子(MIF) 肌钙蛋白I(cTnI) 心脏指数(CI) 

分 类 号：R563.8[医药卫生—呼吸系统]