新型生化标志物在脓毒症心肌损伤中的诊断价值研究进展  

Recent Advances in the Diagnostic Value of New Biochemical Markers of Sepsis-induced Myocardial Injury

作　　者：陈发超 徐银川[1] 张召才[2] CHEN Fachao;XU Yinchuan;ZHANG Zhaocai(Department of Cardiovascular,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Intensive Care Unit,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院心血管内科,浙江省杭州市310009 [2]浙江大学医学院附属第二医院重症医学科,浙江省杭州市310009

出　　处：《中国全科医学》2021年第5期533-538,545,共7页Chinese General Practice

基　　金：国家自然科学基金面上项目(81772110)。

摘　　要：脓毒症心肌损伤(SIMD)可导致患者出现不良预后和高死亡率,对其早期识别并给予积极的治疗至关重要。B型脑钠肽、心肌肌钙蛋白等传统的心肌损伤标志物对SIMD诊断缺乏特异性,本文通过检索相关文献,介绍了新型生化标志物包括微小RNAs(miRNAs)、心型脂肪酸结合蛋白(H-FABP)、妊娠相关血浆蛋白A(PAPPA)、组蛋白、高迁移率族蛋白(HMGB-1)、可溶性髓样细胞触发受体-1(sTREM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)的起源,及其在SIMD中的释放机制,并总结了上述新型生化标志物对SIMD的诊断价值,发现miRNAs不仅对SIMD具有较好的预测价值,同时也可能用于改善SIMD;H-FABP、PAPPA、组蛋白、HMGB-1、sTREM-1、NGAL等新型生化标志物对SIMD均有一定的预测价值,多种标志物组合能够提高对SIMD的诊断能力。鉴于目前多数SIMD相关临床研究患者纳入时采用脓毒症1.0或2.0诊断标准,采用脓毒症3.0诊断标准的研究偏少,在脓毒症3.0诊断时代,上述生化标志物对SIMD的临床诊断价值将受到挑战,多种标志物组合预测SIMD的价值也需要结合新的临床评估手段重新进行评价。Sepsis-induced myocardial damage(SIMD)can lead to poor prognosis and high mortality,so early identification and active treatment are essential.As traditional biomarkers such as cardiac troponin and brain natriuretic peptide are not specific for SIMD,we reviewed the advances in biomarkers for this disease,with detailed summary of the history,release mechanism and diagnostic value of several novel biomarkers〔miRNAs,heart-type fatty acid binding protein(H-FABP),pregnancy-associated plasma protein A(PAPP-A),histone,high mobility group protein-1(HMGB-1),soluble triggering receptor expressed on myeloid cell-1(sTREM-1),and neutrophil gelatinase-associated lipocalin(NGAL)〕in SIMD,and found that miRNAs may be a good predictor as well as an improvement parameter for SIMD,and H-FABP,PAPPA,histone,HMGB-1,sTREM-1 and NGAL may be predictors for SIMD,but the combination of multiple biomarkers may have higher predictive value.In view of the fact that patient enrolment using the sepsis 1.0 or 2.0 diagnostic criteria in majority of SIMD-related clinical studies,and there are few studies using the current sepsis 3.0 criteria,in the era of sepsis 3.0,the value of abovementioned biomarkers for SIMD diagnosis may be challenged,and the power of multi-biomarkers to predict SIMD also needs to be re-evaluated using new clinical evaluation methods.

关 键 词：脓毒症 心肌损伤 生化标志物 诊断价值 灵敏度 特异度 

分 类 号：R631[医药卫生—外科学]