生物标志物联合检测对脓毒性心肌损伤患者早期诊断及预后评估的价值  

Value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury

作　　者：李志宇 崔少华 耿立霞[2] Li Zhiyu;Cui Shaohua;Geng Lixia(Baotou Medical College of Inner Mongolia University of Science and Technology,Baotou 014040,Inner Mongolia Autonomous Region,China;Department of Critical Care Medicine,the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology,Baotou 014010,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古科技大学包头医学院,内蒙古自治区包头014040 [2]内蒙古科技大学包头医学院第一附属医院重症医学科,内蒙古自治区包头014010

出　　处：《中华危重病急救医学》2021年第4期443-448,共6页Chinese Critical Care Medicine

基　　金：内蒙古自治区高等学校科学研究项目(NJZY13248)。

摘　　要：目的探讨生物标志物联合检测对脓毒性心肌损伤患者早期诊断和预后评估的价值。方法收集内蒙古科技大学包头医学院第一附属医院重症监护病房(ICU)2018年10月至2021年1月收治的103例脓毒症患者临床资料,按照入ICU时心肌肌钙蛋白I(cTnI)分为心肌损伤组(cTnI≥0.15μg/L)和非心肌损伤组(cTnI<0.15μg/L)。记录103例患者入ICU 6 h内血清心型脂肪酸结合蛋白(H-FABP)、降钙素原(PCT)、C-反应蛋白(CRP)、肌酸激酶同工酶(CK-MB)、cTnI、N末端脑钠肽前体(NT-proBNP)水平及入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)最差值;同时记录脓毒性心肌损伤患者28 d预后。各项指标的相关性采用Spearman相关分析;绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),分析各项指标及APACHEⅡ评分单独或联合检测对脓毒性心肌损伤患者早期诊断和预后评估的价值。结果①103例脓毒症患者中,合并心肌损伤58例,未合并心肌损伤45例。心肌损伤组患者血清PCT、CRP、NT-proBNP、CK-MB、cTnI、H-FABP水平及APACHEⅡ评分均明显高于非心肌损伤组〔PCT(μg/L):3.46±1.35比1.89±0.43,CRP(mg/L):81.1±26.8比65.3±19.1,NT-proBNP(ng/L):8261.4±2346.9比6120.2±1809.6,CK-MB(U/L):15.89±6.25比12.14±4.24,cTnI(μg/L):1.50(0.91,2.21)比0.18(0.16,0.19),H-FABP(μg/L):26.45±8.24比12.82±5.73,APACHEⅡ评分(分):24.0(18.0,29.0)比16.0(14.0,18.0),均P<0.01〕。Spearman相关分析显示,PCT、CRP、APACHEⅡ评分与心肌损伤标志物NT-proBNP、CK-MB、cTnI、H-FABP均呈显著正相关。ROC曲线分析显示,H-FABP对脓毒性心肌损伤的诊断效能(AUC=0.916)优于NT-proBNP(AUC=0.756)和CK-MB(AUC=0.675);三者联合诊断的AUC可达0.921,敏感度为82.1%,特异度为88.2%。②脓毒性心肌损伤患者28 d存活23例,死亡35例。死亡组患者血清PCT、CRP、NT-proBNP、CK-MB、cTnI、H-FABP水平及APACHEⅡ评分均明显高于存活组〔PCT(μg/L):3.86±1.27比2.84±1.24,CRP(mg/LObjective To investigate the value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury.Methods The clinical data of 103 patients with sepsis admitted to the intensive care unit(ICU)of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from October 2018 to January 2021 were enrolled.According to the cardiac troponin I(cTnI)at admission of ICU,they were divided into septic myocardial injury group(cTnI≥0.15μg/L)and non-septic myocardial injury group(cTnI<0.15μg/L).The serum levels of heart-type fatty acid-binding protein(H-FABP),procalcitonin(PCT),C-reactive protein(CRP),MB isoenzyme of creatine kinase(CK-MB),cTnI and N-terminal pro-brain natriuretic peptide(NT-proBNP)within 6 hours after ICU admission and the worst value of acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours after ICU admission in 103 patients was recorded as well as the 28-day prognosis of patient with septic myocardial injury.Spearman correlation analysis was used to analyze the correlation of each index;receiver operating characteristic curve(ROC curve)was drawn,and the area under ROC curve(AUC)was calculated to analyze the early diagnosis and prognostic value of each index and APACHEⅡscore alone or combined detection in patients with septic myocardial injury.Results①Among 103 patients with sepsis,58 patients were complicated with myocardial injury and 45 patients were not complicated with myocardial injury.The serum levels of PCT,CRP,NT-proBNP,CK-MB,cTnI,H-FABP and APACHEⅡscore in patients with septic myocardial injury were significantly higher than those in patients without septic myocardial injury[PCT(μg/L):3.46±1.35 vs.1.89±0.43,CRP(mg/L):81.1±26.8 vs.65.3±19.1,NT-proBNP(U/L):8261.4±2346.9 vs.6120.2±1809.6,CK-MB(U/L):15.89±6.25 vs.12.14±4.24,cTnI(μg/L):1.50(0.91,2.21)vs.0.18(0.16,0.19),H-FABP(μg/L):26.45±8.24 vs.12.82±5.73,APACHEⅡscore:24.0(18.0,29.0)vs.16.0(14.0,18.0),a

关 键 词：脓毒症 降钙素原 C-反应蛋白 肌酸激酶同工酶 肌钙蛋白I N末端脑钠肽前体 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]