脓毒血症伴发心力衰竭患者血清胱抑素C水平与临床症状的相关性研究  

Correlation between serum cystatin C level of sepsis patients complicated with heart failure and clinical symptoms

作　　者：孙雷[1] 杨初尉 刘宇飞[1] 崔明[1] 王翠翠[1] 隋韶光[1] 

机构地区：[1]大连医科大学附属第二医院急诊科,辽宁大连116033

出　　处：《中华医院感染学杂志》2016年第22期5131-5134,共4页Chinese Journal of Nosocomiology

基　　金：辽宁省科技厅面上项目(201423003)

摘　　要：目的探讨血清胱抑素C对脓毒血症患者心力衰竭发生的影响及相关因素,为临床诊治提供参考。方法选择2014年2月-2016年2月脓毒血症患者136例,其中47例伴发急性心力衰竭,比较不同患者血清胱抑素C水平的差异,并将左室射血分数(LVEF)、左心室舒张末内径(LVDd)、E/e'等指标与胱抑素C水平进行相关分析。结果与单纯脓毒血症患者相比,伴发急性心力衰竭的患者血清胱抑素C的浓度更高(1.84±0.45mg/L vs1.15±0.27mg/L),差异有统计学意义(P<0.05);胱抑素C的水平与年龄、LVEF、LVDd、E/e'等之间存在显著的相关性(P均<0.05);血清胱抑素C浓度≥1.58mg/L者发生急性心力衰竭的风险是浓度<1.58 mg/L者的1.68倍,而且发生LVEF≤40%、LVDd≥60mm、E/e'≥17发生的风险也增高。结论伴发心力衰竭的脓毒血症患者血清胱抑素C水平明显增高,且升高的比例与发生急性心力衰竭的风险、异常心脏功能指标呈正相关,提示胱抑素C可作为临床早期识别脓毒血症患者发生急性心力衰竭的生物学指标。OBJECTIVE To explore the influence of serum cystatin C on incidence of heart failure in patients with sepsis and analyze the related factors so as to provide guidance for clinical diagnosis and treatment .METHODS A total of 136 patients with sepsis who were treated in the hospital from Feb 2014 to Feb 2016 were enrolled in the study ,including 47 patients complicated with acute heart failure .The level of serum cystatin C was compared a‐mong the patients ;the correlation between the indexes such as left ventricular ejection fraction （LVEF） ,left ven‐tricular end diastolic diameter （LVDd） and E/e＆#39;and the level of cystatin C was analyzed .RESULTS As compared with the patients with single sepsis ,the sepsis patients complicated with acute heart failure had even higher con‐centration of serum cystatin C （1 .84 ± 0 .45 mg/L vs 1 .15 ± 0 .27mg/L） ,and there was significant difference （P〈0 .05） .The cystatin C level was remarkably associated with the age ,LVEF ,LVDd ,and E/e＆#39;（all P〈0 .05） . The patients with the serum cystatin C concentration no less than 1 .58 mg/L were 1 .68 times at risk of heart fail‐ure as the patients with the serum cystatin C concentration less than 1 .58 mg/L ;the patients with the LVEF no more than 40% ,LVDd no less than 60mm ,or E/e＆#39;no less than 17 were also at increasing risk of heart failure . CONCLUSION The level of serum cystatin C is remarkably elevated in the sepsis patients complicated with heart failure ,and the increasing proportion is positively correlated with the risk of acute heart failure and abnormal car‐diac function indexes ,indicating that the cystatin C can be used as a biological indicator for early clinical identifica‐tion of acute heart failure in the sepsis patients .

关 键 词：脓毒血症 心力衰竭 胱抑素C 

分 类 号：R631.2[医药卫生—外科学]