脓毒症并发肺动脉高压临床特征及危险因素分析  

The analysis on clinical characteristics and risk factors in patients with sepsis-associated pulmonary hypertension

作　　者：沈林霞[1] 郑亚安[1] 田兆兴[1] 闫崴[2] Shen Linxia;Zheng Ya＇an;Tian Zhaoxing;Yan Wei(Emergency Department, Peking University third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院急诊科,北京100191 [2]北京大学第三医院呼吸科,北京100191

出　　处：《中华急诊医学杂志》2018年第4期384-388,共5页Chinese Journal of Emergency Medicine

基　　金：国家百然科学基金（81172745）

摘　　要：目的分析脓毒症并发肺动脉高压（PH）的临床特征及危险因素。方法回顾性分析北京大学第三医院急诊科人院24h内出现脓毒症患者136例，根据是否出现PH，分为PH组和非PH组，比较两组一般情况、常规实验室检查结果及超声心动检测指标，分析脓毒症并发PH患者的临床特征。用多因素Logistic回归法分析脓毒症并发PH的独立危险因素，绘制受试者工作特征曲线（ROC曲线）评价左房内径的预测价值。结果136例患者中32例并发PH，发病率为23．5％。两组间年龄、性别、心率、平均动脉压、APACHE-Ⅱ评分及SOFA评分等基线资料以及血红蛋白、血小板计数、红细胞比容、白蛋白、血肌酐、肌钙蛋白Ⅰ、降钙素原、D-二聚体、酸碱度和乳酸比较差异均无统计学意义（P〉0．05）；与非PH组比较，PH组氧合指数减低[（291．90±51．62）与（326．40±88．16），P=0．017]，NT-proBNP[1gNT-proBNP（3．67±0．41）与（3．33±0．59），P=0．003]水平升高，超声心动图检测E值[（86．12±30．43）与（67．73±21．49），P=0．008]、E／A值[（1．09±0．46）与（0．83±0．29），P=0．014]和左房内径增大[（36．49±5．97）与（31．32±4．69），P=0．001]，两组间比较差异均有统计学意义（P〈0．05）；多因素Logistic回归分析显示，左房内径（OR=1．198，P=0．0101是脓毒症并发PH的独立危险因素；ROC曲线显示，左房内径为31mm时预测脓毒症并发PH的曲线下面积为0．723，敏感度为82．6％，特异度为49．0％。结论左房内径是脓毒症并发PH的独立危险因素。Objective To analyze clinical characteristics and risk factors of pulmonary hypertension （PH） in patients with sepsis. Methods According to retrospective analysis of clinical data 136 cases with sepsis were divided into PH group and non-PH group. The clinical data, laboratory findings and ultrasonic cardiographic findings were recorded and compared between two groups. Multi-factors Logistic regression analysis was performed to find the independent risk factors of PH in patients with sepsis, and receiver operating characteristic curve ROC was constructed to indicate the predictable value. Results Of 136 patients with sepsis, 32 （23.5%） developed PH. The PH group had higher NT-proBNP [lgNT-proBNP （3.67±：0.41） vs. （3.33±0.59）, P=0.003], higher E peak [（86.12±30.43） vs. （67.73±21.49）, P=0.008], higher E/A peak [（1.09±0.46） vs. （0.83±0.29）, P=0.014], higher left atrium diameter （LAD） [（36.49±5.97） vs. （31.32±4.69）, P=0.001 ] and lower oxygenation index [（291.90±51.62） vs. （326.40±88.16）, P=0.017] than the non-PH group （P 〈 0.05）. It was shown by multi-factors Logistic regression analysis that LAD （OR=1. 198, P=0.010） was an independent risk factor of PH in patients with sepsis. The area under the curve AUC of LAD was 0.723, with the cut-off value of 31 mm （sensibility 82.6%, specificity 49.0%）. Conclusions LAD was an independent risk factor of sepsis-associated pulmonary hypertension in sepsis patients.

关 键 词：脓毒症 肺动脉高压 三尖瓣反流速率 左房内径 N末端脑钠肽前体 氧合指数 二尖瓣口舒张早期血流峰速度 二尖瓣口舒张晚期血流峰速度 

分 类 号：R459.7[医药卫生—急诊医学] R544.1[医药卫生—治疗学]