血清H-FABP联合sTREM-1对脓毒症心肌功能障碍的诊断价值  

The diagnostic value of serum H-FABP combined with sTREM-1 on myocardial dysfunction in sepsis

作　　者：汪洋[1] 黄园琴[1] 刘晓辉[2] 刘彬[1] 田青[1] 肖红艳[3] Wang Yang;Huang Yuanqin;Liu Xiaohui;Liu Bin;Tian Qing;Xiao Hongyan(ICU,Wuhan Asian Heart Hospital,Hubei Province,Wuhan 430022,China;不详)

机构地区：[1]武汉亚洲心脏病医院重症监护室,430022 [2]武汉亚洲心脏病医院检验科,430022 [3]武汉亚洲心脏病医院心外科,430022

出　　处：《疑难病杂志》2022年第3期237-241,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省卫生健康委员会科研项目(WJ2019F024)。

摘　　要：目的分析血清心型脂肪酸结合蛋白(H-FABP)联合可溶性髓系细胞触发受体-1(sTREM-1)对脓毒症心肌功能障碍(SIMD)的诊断价值。方法选取2020年1月—2021年7月武汉亚洲心脏病医院重症监护室收治的脓毒症患者212例(脓毒症组),根据是否合并心肌功能障碍分为SIMD亚组84例和非SIMD亚组128例,另选取同期健康体检者60例为健康对照组。ELISA法检测2组血清H-FABP、sTREM-1水平,多因素Logistic回归分析SIMD影响因素,受试者工作特征曲线(ROC)分析血清H-FABP、sTREM-1对SIMD的诊断价值。结果与健康对照组比较,脓毒症组血清H-FABP、sTREM-1水平明显升高(Z/P=9.259/<0.001,8.458/<0.001)。与非SIMD亚组比较,SIMD亚组慢性阻塞性肺疾病比例和血清心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)、H-FABP、sTREM-1水平明显升高(χ^(2)/t/Z/P=4.530/0.033、2.253/0.024、2.368/0.018、6.033/<0.001、6.405/<0.001)。多因素Logistic回归分析显示,血清cTnI、BNP、H-FABP、sTREM-1升高为SIMD独立危险因素[OR(95%CI)=2.180(1.167~4.071)、1.353(1.133~1.617)、1.296(1.175~1.430)、1.978(1.043~3.751)]。ROC曲线显示,血清H-FABP、sTREM-1及二者联合诊断SIMD的曲线下面积(AUC)分别为0.745、0.760、0.849,敏感度分别为0.524、0.941、0.881,特异度分别为0.867、0.476、0.688。二者联合诊断SIMD的效能高于单独检测(Z=3.790、3.528,P均<0.001)。结论脓毒症患者血清H-FABP、sTREM-1水平升高,是SIMD独立危险因素,二者联合检测能提升SIMD诊断价值。Objective To analyze the diagnostic value of serum heart-type fatty acid-binding protein(H-FABP)combined with soluble myeloid cell trigger receptor-1(sTREM-1)in septic myocardial dysfunction(SIMD).Methods A total of 212 sepsis patients(sepsis group)admitted to the intensive care unit of Wuhan Asian Heart Hospital from January 2020 to July 2021 were selected and divided into SIMD subgroup of 84 cases and non-SIMD subgroup according to whether they were complicated with myocardial dysfunction or not.There were 128 cases in the group,and 60 healthy subjects who underwent physical examination during the same period were selected as the healthy control group.The levels of serum H-FABP and sTREM-1 in the two groups were detected by ELISA,the influencing factors of SIMD were analyzed by multivariate Logistic regression,and the diagnostic value of serum H-FABP and sTREM-1 in SIMD was analyzed by receiver operating characteristic curve(ROC).Results Compared with the healthy control group,the levels of serum H-FABP and STREM-1 in the sepsis group were significantly increased(Z/P=9.259/<0.001,8.458/<0.001).Compared with the non-SIMD subgroup,the proportion of chronic obstructive pulmonary disease and the serum levels of cardiac troponin I(cTnI),brain natriuretic peptide(BNP),H-FABP,and sTREM-1 in the SIMD subgroup were significantly increased(χ^(2)/t/Z/P=4.530/0.033,2.253/0.024,2.368/0.018,6.033/<0.001,6.405/<0.001).Multivariate Logistic regression analysis showed that elevated serum cTnI,BNP,H-FABP,and STREM-1 were independent risk factors for SIMD[OR(95%CI)=2.180(1.167-4.071),1.353(1.133-1.617),1.296(1.175-1.430),1.978(1.043-3.751)].The ROC curve showed that the areas under the curve(AUC)of serum H-FABP,sTREM-1 and their combination in the diagnosis of SIMD were 0.745,0.760,and 0.849,respectively,the sensitivities were 0.524,0.941,and 0.881,and the specificities were 0.867 and 0.476,0.688,respectively.The combined efficacy of the two in the diagnosis of SIMD was higher than that of single detection(Z=3.790,3.528,both P<0

关 键 词：脓毒症 心肌功能障碍 心型脂肪酸结合蛋白 可溶性髓系细胞触发受体-1 诊断 

分 类 号：R515.3[医药卫生—内科学]