脓毒性心肌病临床诊断评分体系的构建及效能评估  

Establishment and evaluation of clinical diagnostic scoring system for septic cardiomyopathy

作　　者：商娜 刘慧珍[1] 王娜[1] 李俊玉[1] 王雅慧 刘芦姗[1] 郭树彬 Shang Na;Liu Huizhen;Wang Na;Li Junyu;Wang Yahui;Liu Lushan;Guo Shubin(Department of Emergency Medicine,China Rehabilitation Research Center Beijing Bo'ai Hospital,Beijing 100068,China;Emergency Medicine Clinical Research Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)

机构地区：[1]中国康复研究中心北京博爱医院急诊科,北京100068 [2]首都医科大学北京朝阳医院急诊医学临床研究中心,心肺脑复苏北京市重点实验室,北京100020

出　　处：《中华危重病急救医学》2021年第12期1409-1413,共5页Chinese Critical Care Medicine

基　　金：北京市丰台区卫生健康系统科研项目(2019-119)。

摘　　要：目的建立脓毒性心肌病(SCM)的临床诊断评分体系,并评价其诊断效能。方法采用前瞻性队列研究方法,连续入选2019年1月至2020年12月就诊于中国康复研究中心急诊科的脓毒症和脓毒性休克患者。收集患者一般资料、既往史,入院时心率(HR)、平均动脉压(MAP)、体温、呼吸频率(RR),测定白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)、血乳酸(Lac)等实验室指标,入院24 h内、第7 d分别行经胸超声心动图,并进行序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、营养风险筛查2002量表(NRS2002)评分。根据是否发生SCM将患者分为SCM组和非SCM组,采用单因素及多因素Logistic回归分析筛选影响SCM发生的危险因素;绘制受试者工作特征曲线(ROC曲线)确定连续型指标的截断值并参考临床进行离散化,根据各变量的β回归系数设立相应分值,建立SCM的临床诊断评分体系,采用ROC曲线评价该模型的诊断效能。结果共入选147例脓毒症和脓毒性休克患者,SCM的发生率为28.6%(42/147)。单因素Logisitc回归分析初步筛选自变量后显示,影响SCM的危险因素包括:①连续型指标:年龄、NT-proBNP、RR、MAP、Lac、NRS2002、SOFA评分、APACHEⅡ评分;②离散型指标:休克、使用血管活性药物、有冠心病病史、合并急性肾损伤(AKI)。对连续型指标离散化后进行多因素Logistic回归分析显示,年龄≥87岁、NT-proBNP≥3000 ng/L、RR≥30次/min、Lac≥3 mmol/L、SOFA≥10分是影响SCM的独立危险因素〔年龄≥87岁:优势比(OR)=3.491,95%可信区间(95%CI)为1.371~8.893,P=0.009;NT-proBNP≥3000 ng/L:OR=2.708,95%CI为1.093~6.711,P=0.031;RR≥30次/min:OR=3.404,95%CI为1.356~8.541,P=0.009;Lac≥3.0 mmol/L:OR=3.572,95%CI为1.460~8.739,P=0.005;SOFA≥10分:OR=8.693,95%CI为2.541~29.742,P=0.001〕。成功构建的SCM临床诊断评分体系总分为6分,包括年龄≥87岁(1分)、NT-proBNP≥3000 Objective To establish a clinical diagnostic scoring system for septic cardiomyopathy(SCM)and evaluate its diagnostic efficacy.Methods A prospective cohort study was performed.Patients with sepsis and septic shock admitted to the department of emergency of China Rehabilitation Research Center were enrolled from January 2019 to December 2020.The baseline information,medical history,heart rate(HR),mean arterial pressure(MAP),body temperature and respiratory rate(RR)on admission were recorded.Laboratory indexes such as white blood cell count(WBC),hypersensitivity C-reactive protein(hs-CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP),and blood lactic acid(Lac)were measured.Transthoracic echocardiography was conducted within 24 hours and on the 7th after admission.Sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ),and nutritional risk screening 2002 scale(NRS2002)were also assessed.The patients were divided into two groups according to whether SCM occurred or not.The risk factors of SCM were screened by univariate and multivariate Logistic regression.The cut-off value of continuous index was determined by receiver operator characteristic curve(ROC curve)and discretized concerning clinical data.The regression coefficient β was used to establish the corresponding score,and the clinical diagnostic score system of SCM was established.The diagnostic value of the model was evaluated by ROC curve.Results In total,147 patients were enrolled in the study and the incidence of SCM was 28.6%(42/147).Univariate Logistic regression analysis showed the risk factors of SCM included:①continuous indicators:age,NT-proBNP,RR,MAP,Lac,NRS2002,SOFA,APACHEⅡ;②discrete indicators:shock,use of vasoactive drugs,history of coronary heart disease,acute kidney injury(AKI).Multivariate Logistic regression analysis after discretization of above continuous index showed that age≥87 years old,NT-proBNP≥3000 ng/L,RR≥30 times/min,Lac≥3 mmol/L and SOFA≥10 points were independ

关 键 词：脓毒性心肌病 临床诊断评分体系 诊断效能 

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