血清多配体蛋白聚糖-4、胰岛素样生长因子结合蛋白7与脓毒症合并左心室心肌舒张功能障碍患者预后的关系  

Relations of serum concentrations of syndecan-4,insulin-like growth factor-binding protein 7 and prog⁃nosis of patients with sepsis complicated with left ventricular diastolic dysfunction

作　　者：刘国凤 唐晋[2] 左小平[3] LIU Guo-feng;TANG Jin;ZUO Xiao-ping(Department of Blood Transfusion,Guang′an People′s Hospital(Guangan Hospital,West China Hospital,Sichuan University),Guang′an,Sichuan 638000,China;Department of Critical Care Medicine,Guang′an People′s Hospital(Guangan Hospital,West China Hospital,Sichuan University),Guang′an,Sichuan 638000,China;Department of Cardiothoracic Surgery,Guang′an People′s Hospital(Guangan Hospital,West China Hospital,Sichuan University),Guang′an,Sichuan 638000,China)

机构地区：[1]广安市人民医院(四川大学华西医院广安医院)输血科,四川广安638000 [2]广安市人民医院(四川大学华西医院广安医院)重症医学科,四川广安638000 [3]广安市人民医院(四川大学华西医院广安医院)胸外科,四川广安638000

出　　处：《岭南心血管病杂志》2022年第4期339-343,348,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨血清多配体蛋白聚糖-4(syndecan-4,SDC-4)、胰岛素样生长因子结合蛋白7(insulin-like growth factor-binding protein 7,IGFBP7)预测脓毒症合并左心室心肌舒张功能障碍患者预后的价值。方法选择2019年1月至2020年6月广安市人民医院收治的104例脓毒症患者,超声心动图检测患者的左心室充盈压(left ventricular filling pressure,LVFP),根据LVFP测量结果将其分为左心室心肌舒张功能障碍组(LVFP>15 mmHg,n=43,1 mmHg=0.133 kPa)和无左心室心肌舒张功能障碍组(LVFP≤15 mmHg,n=61)。根据左心室心肌舒张功能障碍组患者住院30 d内存活情况分为死亡亚组(n=15)和存活亚组(n=28)。采用酶联免疫吸附试验(ELISA)法检测血清SDC-4、IGFBP7浓度,分析SDC-4、IGFBP7与超声心动图参数的相关性以及SDC-4、IGFBP7浓度预测脓毒症合并左心室心肌舒张功能障碍患者预后的价值。结果左心室心肌舒张功能障碍组患者心尖方向测量舒张末期室间隔厚度(interventricular septal thickness,IVST)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、LVFP、血清SDC-4及IGFBP7浓度高于无左心室心肌舒张功能障碍组,差异有统计学意义(均P<0.05);左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、二尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值(ratio of early diastolic transmitral inflow velocity to late diastolic mitral annulus velocity,E/A)低于无左心室心肌舒张功能障碍组,差异有统计学意义(均P<0.05)。血清SDC-4、IGFBP7浓度与IVST、LVPWT、LVFP均呈正相关(均P<0.05),与LVEDV、E/A比值呈负相关(均P<0.05)。死亡组患者血清SDC-4、IGFBP7浓度高于存活组亚患者,差异有统计学意义(均P<0.05)。SDC-4、IGFBP7、联合SDC-4和IGFBP7预测脓毒症合并左心室心肌舒张功能障碍患者预后不良的曲线下面积(AUC)分别为0.788、0.852、0.902,联合SDC-4和IGFBP7的曲线下面积高于单独SDC-4、IGFBPObjectives To investigate the correlations between serum concentrations of syndecan-4(SDC-4),insulin like growth factor-binding protein 7(IGFBP7)and prognosis of patients with sepsis complicated with left ventricular diastolic dysfunction.Methods Totally 104 patients with sepsis admitted to Guang′an People′s Hospital from January 2019 to June 2020 were selected and their left ventricular filling pressures(LVFP)were detected by echocardiography.According to the LVFP measurement results,they were divided into left ventricular diastolic dysfunction group(LVFP>15 mmHg,n=43,1 mmHg=0.133 kPa)and non left ventricular diastolic dysfunction group(LVFP≤15 mmHg,n=61).Patients in left ventricular diastolic dysfunction group were divided into death subgroup(n=15)and survival sub group(n=28)according to their survival within 30 days after hospitalization.Serum concentrations of SDC-4 and IGFBP7 were detected by enzyme-linked immunosorbent assay(ELISA).The correlations between SDC-4,IGFBP7 and echocar⁃diographic parameters,as well as the prognostic value of SDC-4 and IGFBP7 in patients with sepsis complicated with left ventricular diastolic dysfunction were analyzed.Results Interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),LVFP,serum concentrations of SDC-4 and IGFBP7 in left ventricular diastolic dysfunction group were significantly higher than those in non left ventricular diastolic dysfunction group(all P<0.05),and left ventricular end-diastolic volume(LVEDV)and ratio of early diastolic transmitral inflow velocity to late diastolic mitral annulus velocity(E/A)were significantly lower than those in non left ventricular diastolic dysfunction group(all P<0.05).Serum concentrations of SDC-4 and IGFBP7 positively correlated with IVST,LVPWT and LVFP(all P<0.05),and negatively correlated with LVEDV and E/A(all P<0.05).Serum concentrations of SDC-4 and IGFBP7 in death subgroup were significantly higher than those in survival subgroup(all P<0.05).The area under the curve(AUC)of SDC-4,IGF

关 键 词：多配体蛋白聚糖-4 胰岛素样生长因子结合蛋白7 脓毒症 心肌舒张功能障碍 预后 

分 类 号：R541.6[医药卫生—心血管疾病]