高敏肌钙蛋白T与重症患者脓毒症及预后的关系  

Relationship between highly sensitive cardiac troponin T and sepsis and outcome in critically ill patients

作　　者：王婷婷 姜利[1] 

机构地区：[1]首都医科大学附属复兴医院重症医学科,100038

出　　处：《中华内科杂志》2017年第10期738-742,共5页Chinese Journal of Internal Medicine

基　　金：国家科技支撑计划（2012BAI11B05）

摘　　要：目的探讨高敏肌钙蛋白T与重症患者脓毒症及预后的关系。方法选2014年3—12月首都医科大学附属复兴医院重症医学科预计入住时间≥24 h者。入ICU 2 h内检测所有受试者（脓毒症与非脓毒症患者，不同严重程度的脓毒症患者，存活者与死亡者）的血清肌钙蛋白水平。线性回归分析影响高敏肌钙蛋白T水平的因素。多因素logistic回归分析影响重症患者28 d死亡的危险因素。结果共入选125例重症患者，其中脓毒症患者68例（脓毒症者15例，严重脓毒症者26例，感染性休克者27例），非脓毒症患者57例。脓毒症患者高敏肌钙蛋白T水平显著高于非脓毒症患者[52.0（32.5，87.5） ng/L比14.0（6.5，29.0） ng/L, P〈0.001]，但不同严重程度脓毒症者间高敏肌钙蛋白T水平差异无统计学意义（P＝0.705）。死亡者高敏肌钙蛋白T水平显著高于存活者[27（13，52） ng/L比44.5（28.8，83.5） ng/L，P〈0.001]。多因素线性回归分析显示，年龄、血肌酐及是否脓毒症是影响高敏肌钙蛋白T水平的独立因素（P〈0.05）。多因素logistic回归分析显示，序贯器官衰竭评估与血肌酐是重症患者28 d死亡的独立危险因素，而高敏肌钙蛋白T水平不是重症患者28 d死亡的独立危险因素（P＝0.45）。结论脓毒症患者入ICU时的高敏肌钙蛋白T水平显著高于非脓毒症患者，脓毒症会影响其水平，但未发现高敏肌钙蛋白T水平与脓毒症严重程度相关。死亡者也有较高的高敏肌钙蛋白T水平。多因素logistic回归分析提示，高敏肌钙蛋白T水平不是重症患者28 d死亡的独立危险因素。ObjectiveTo investigate the prognostic value of highly sensitive cardiac Troponin T （hs-cTn T） for sepsis in critically ill patients.MethodsPatients estimated to stay in the ICU of Fuxing Hospital for more than 24h were enrolled at from March 2014 to December 2014. Serum hs-cTn T was tested within two hours. Univariate and multivariate linear regression analyses were used to determine the association of variables with the hs-cTn T. Multivariable logistic regression analysis was used to evaluate the risk factors of 28-day mortality.ResultsA total of 125 patients were finally enrolled including 68 patients with sepsis and 57 without. The levels of hs-cTn T in sepsis and non-sepsis groups were significantly different[52.0（32.5, 87.5） ng/L vs 14.0（6.5, 29.0） ng/L respectively, P〈0.001]. In sepsis group, hs-cTn T among common sepsis, severe sepsis and septic shock were similar. Hs-cTn T was significantly higher in non-survivors than survivors [27（13, 52）ng/L vs 44.5（28.8, 83.5）ng/L, P〈0.001]. Age, sepsis, serum creatinine were independent risk factors affecting hs-cTn T by multivariate linear regression analyses. But hs-cTn T was not a risk factor for death.ConclusionPatients with sepsis had higher serum hs-cTn T than those without sepsis. but it was not found to be associated with the severity of sepsis.

关 键 词：高敏肌钙蛋白T 脓毒症 感染性休克 预后 

分 类 号：R459.7[医药卫生—急诊医学]