心肌肌钙蛋白T与脓毒症心功能障碍相关性及预后的研究  

The relationship between cardiac troponin T and cardiac dysfunction in septic patients

作　　者：邓彦俊[1] 李振华[1] 王国兴[1] 谢苗荣[1] 

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《临床和实验医学杂志》2017年第10期954-958,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市教育委员会科技发展计划面上项目(编号:KM201310025016)

摘　　要：目的探讨脓毒症患者血清心肌肌钙蛋白T(cTnT)与脓毒症患者心功能障碍的关系及其对脓毒症患者预后的评估价值。方法前瞻性收集脓毒症患者120例作为研究对象,检测入院后第1、3、7天血清cTnT水平,根据患者入院后1天血清cTnT<0.1 ng/ml,cTnT≥0.1 ng/ml分为心肌非损伤组(56例)与心肌损伤组(64例),并同步做超声心动图检查,判断cTnT与超声心动图指标动态变化的相关性。根据患者28内存活、28天内死亡分为死亡组(26例)和存活组(94例),确定脓毒症心功能障碍的独立危险因素,明确血清cTnT能否预测脓毒症预后,并判断其对脓毒症患者心功能障碍预后的预测价值。结果入院当天,心肌损伤组与心肌非损伤组对比,其左室舒张末内径(EDD)、左室收缩末内径(ESD)间有统计学差异。射血分数(EF)值与入院当天cTnT值无明显相关性。当TnT≥0.1 ng/ml时,cTnT水平与左室射血分数(LVEF)、二尖瓣口舒张早期最大流速与心房收缩期最大流速比值(E/A)呈负相关性,与EDD、ESD呈正相关性。患者28天死亡情况与E/A、LVEF及cTnT均有明显相关性,cTnT水平对预测死亡具有统计学意义,ROC曲线上敏感度、特异度均较高的临界点为第3天,cTnT>0.373 ng/ml将其作为预测死亡的临界点,敏感度为80.7%,特异度为95.7%。超声心动图中E/A值对预测死亡具有明显统计学意义,ROC曲线上敏感度、特异性均较高的临界点为第1天,E/A<0.87。将其作为预测死亡的临界点,敏感度为92.67%,特异度为89.69%。结论脓毒症患者cTnT水平与其心功能障碍存在相关性,脓毒症患者出现心功能障碍早期主要以舒张功能障碍为主,当出现收缩功能障碍时,患者预后更加不良,心功能障碍发生率越高,患者死亡率也越高,血清cTnT值越高,患者死亡率越高,早期监测患者cTnT及超声心动图指标(尤其是E/A)可在一定程度上反映患者心功能障碍的程度及预后,cTnT>0.373 ng/ml及E/A<0.87Objective To explore the relationship between serum cardiac troponin-T （cTnT） and cardiac dysfunction, and the prognostic value of cTnT in patients with sepsis.Methods 120 patients with sepsis were included prospectively as the study subjects, from whom the serum cTnT levels at 1, 3 and 7d post-admission were collected and echocardiography was performed simultaneously to assess the correlation between cTnT and the dynamic changes in the echocardiographic indicators.Among them, there were 64 cases of myocardial injury group and 56 cases of myocardial non-injury group.Patients were divided into two groups by whether survival within 28d, 26 cases of death group, 94 cases of survival group, so as to determine the independent risk factors for cardiac dysfunction in sepsis, the prognostic value of serum cTnT for sepsis, and the prognostic value of serum cTnT for cardiac dysfunction in sepsis.Results On the day of admission, there were statistically significant differences between cTnT and EDD and between cTnT and ESD, Serum cTnT presented no significant correlation with EF;in the presence of TnT=0.1 ng/ml, cTnT level presented negative correlation with LVEF and E/A, and positive correlation with EDD and ESD.Patient death within 28d presented significant correlation with E/A, LVEF and cTnT;cTnT presented statistically significant predictive value for death;the critical point on the ROC curve with both high sensitivity and specificity was Day 3, cTnT〉0.373 ng/ml was regarded as the critical point for predicting death, and the sensitivity was 80.7% and the specificity was 95.7%.E/A ratio in echocardiography presented statistically significant predictive value for death;the critical point on the ROC curve with both high sensitivity and specificity was Day 1, with E/A〈0.87 being regarded as the critical point for predicting death, and the sensitivity was 92.67% and the specificity was 89.69%.Conclusion In patients with sepsis, cTnT level presented correlation with cardiac dysfunction, which in early stages is predom

关 键 词：脓毒症 心肌肌钙蛋白T 心脏功能 预后 

分 类 号：R459.7[医药卫生—急诊医学]