肌红蛋白变化对脓毒症相关慢性重症患者预后的预测价值  

The prognostic value of myoglobin difference in sepsis related chronic critical illness

作　　者：顾彬 刘宁[1] 聂垚[1] 刘紫锰[1] 刘勇军[1] 陈敏英[1] 吴健锋[1] 管向东[1] Gu Bin;Liu Ning;Nie Yao;Liu Zimeng;Liu Yongjun;Chen Minying;Wu Jianfeng;Guan Xiangdong(Department of Critical Care Medicine,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院重症医学科,广州510080

出　　处：《中华内科杂志》2021年第4期350-355,共6页Chinese Journal of Internal Medicine

基　　金：中国博士后科学基金资助项目 (2019M653206)。

摘　　要：目的探讨肌红蛋白(Mb)变化对脓毒症相关慢性重症(CCI)患者预后的预测价值。方法选2017年1月至2020年3月中山大学附属第一医院重症医学科一科诊断为脓毒症相关CCI的患者。收集所有患者基线资料,记录入ICU第1天和第14天患者Mb水平,记录28 d内患者生存情况。Kaplan-Meier曲线分析患者28 d累积存活率,Cox比例风险回归模型分析患者死亡的独立危险因素,受试者操作特征(ROC)曲线评估Mb变化值对患者预后的预测价值。结果最终纳入131例脓毒症相关CCI患者,Mb升高者58例,Mb降低者73例。Mb升高者入ICU第1天Mb水平显著低于Mb降低者[172.40(59.99, 430.53)μg/L 比 413.60(184.40, 1 328.50)μg/L,Z=3.749,P=0.000];第14天,Mb升高者Mb水平显著高于Mb降低者[483.65(230.38, 1 471.75)μg/L 比 132.20(76.86, 274.35)μg/L,Z=5.595,P=0.000]。Kaplan-Meier生存曲线分析显示,Mb升高者28 d累积存活率(65.52%)显著低于Mb降低者(84.93%)(χ^(2)=7.051,P=0.008)。Cox比例风险回归模型分析显示,Mb升高是脓毒症相关CCI患者28 d死亡的独立危险因素(OR=2.534,95%CI 1.212~5.295,P=0.013)。ROC曲线分析显示,Mb升高预测脓毒症相关CCI患者28 d内死亡的敏感度为64.5%,特异度为32.0%,曲线下面积(AUC)为0.661(95%CI 0.550~0.773,P=0.007),约登指数为0.325。结论 Mb升高是脓毒症相关CCI患者28 d内死亡的独立危险因素,可作为预测脓毒症相关CCI患者预后指标之一。Objective To investigate the predictive value of myoglobin(Mb)for the prognosis of sepsis related chronic critical illness(CCI).Methods Retrospective study was conducted on septic patients with the length of ICU stay equal or greater than 14 days,and sepsis-related organ failure assessment(SOFA)score equal or greater than 2 on the 14th day in ICU in the First Department of Critical Care Medicine at the First Affiliated Hospital of Sun Yat-sen University from January 2017 to March 2020.Patients′clinical and laboratory data were collected on the 1st and 14th day in ICU.The survival on day 28 in ICU was recorded.According to the myoglobin levels on day 1 and day 14,all subjects were divided into myoglobin elevation group and decline group.Kaplan-Meier survival curve was used to compare the cumulative survival rate at day 28.Cox regression analysis was used to analyze the independent risk factors of mortality.Receiver operating characteristic(ROC)curve was used to analyze the prognostic value of myoglobin.Results A total of 131 patients with sepsis related CCI were recruited,including 58 patients in the elevation group and 73 in the decline group.The Mb level in elevation group on day 1 was significantly lower than that in decline group[172.40(59.99,430.53)μg/L vs.413.60(184.40,1328.50)μg/L,Z=3.749,P=0.000],and the Mb level on day 14 was the opposite change in two groups[483.65(230.38,1471.75)μg/L in elevation group vs.132.20(76.86,274.35)μg/L in decline group,Z=5.595,P=0.000].Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate of the elevation group was significantly lower than that of decline group(χ²=7.051,P=0.008).Cox ratio regression analysis suggested that elevated myoglobin was an independent risk factor for 28-day mortality in septic patients with CCI(OR=2.534,95%CI 1.212-5.295,P=0.013).ROC curve analysis suggested that the sensitivity of myoglobin elevation in predicting mortality related to CCI within 28 days was 64.5%,and the specificity was 32.0%with area under the

关 键 词：肌红蛋白 脓毒症 慢性重症 预后 

分 类 号：R459.7[医药卫生—急诊医学]