血清NT-proBNP、HBDH诊断老年脓毒症继发心功能不全的价值  

The value of serum NT-proBNP and HBDH in the diagnosis of secondary cardiac dysfunction in elderly patients with sepsis

作　　者：范彦琦 陈洁[1] 卢广轩 刘汝明 安曙光 贾伯康 杨淑娟 张健昌 李盘石 FAN Yan-qi;CHEN Jie;LU Guang-xuan;LIU Ru-ming;AN Shu-guang;JIA Bo-kang;YANG Shu-juan;ZHANG Jian-chang;LI Pan-shi(Department of Critical Care Medicine,Dongguan People′s Hospital,the Tenth Affiliated Hospital of Southern Medical University,Dongguan 523000,Guangdong,China)

机构地区：[1]南方医科大学第十附属医院东莞市人民医院重症医学科,广东东莞523000

出　　处：《广东医学》2024年第4期403-407,共5页Guangdong Medical Journal

基　　金：广东省基础与应用基础研究基金项目(2020A1515110919)。

摘　　要：目的探讨氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、羟丁酸脱氢酶(hydroxybutyrate dehydrogenase,HBDH)诊断老年脓毒症患者继发心功能不全的价值。方法采取病例对照研究方法,将2020年1月至2021年12月收治的老年脓毒症患者80例作为研究对象,根据患者是否并发心功能不全将其分为心力衰竭组36例、非心力衰竭组44例,对比两组患者的超声心动图指标、NT-proBNP、HBDH及炎症因子水平;并采用受试者工作特征(receiver operating characteristic,ROC)曲线分析超声心动图指标及NT-proBNP、HBDH诊断脓毒症并发心功能不全的价值。结果心力衰竭组患者的左室射血分数(left ventricular ejection fractions,LVEF)、每搏输出量(stroke volume variation,SVV)、心输出量(cardiac output,CO)、左室短轴缩短率(fraction shortening,FS)、二尖瓣口舒张早期血流速度/二尖瓣口舒张晚期血流速度(mitral early diastolic inflow velocity/mitral late diastolic inflow velocity,E/A)测定值均显著低于非心力衰竭组患者,差异均有统计学意义(P<0.05)。心力衰竭组患者的NT-proBNP、HBDH、白细胞介素-6(interleukin,IL-6)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)、降钙素原(procalcitonin,PCT)、APACHEⅡ评分、Sofa评分均显著高于非心力衰竭组患者,差异均有统计学意义(P<0.05);心力衰竭组和非心力衰竭组患者的C反应蛋白(C-reactive protein,CRP)水平比较,差异无统计学意义(P>0.05)。对36例脓毒症并发心功能损伤患者的NT-proBNP、HBDH测定值与超声心动图指标进行相关性分析,结果显示:NT-proBNP与LVEF、SVV、CO、FS、E/A均呈显著负相关关系(P<0.05),HBDH测定值与患者的LVEF、FS呈显著负相关关系(P<0.05)。NT-proBNP、HBDH、NT-proBNP+HBDH诊断脓毒症患者并发心功能不全的敏感度分别为76.17%、48.52%、92.41%,特异度分别为91.90%、89.20%、84.58%,ROC曲线下面积(AUC)值分别为0.893、0.757、0.944。结论Objective To evaluate the value of N-terminal pro-brain natriuretic peptide(NT-proBNP)and hydroxybutyrate dehydrogenase(HBDH)in diagnosing secondary heart failure in elderly patients with sepsis.Methods A case-control study was conducted,with 80 elderly patients with sepsis from January 2020 to December 2021 as the study subjects.Patients were divided into a heart failure group(36 cases)and a non-heart failure group(44 cases)based on whether they had concurrent heart failure.The echocardiographic indicators,NT-proBNP,HBDH,and levels of inflammatory factors between the two groups were compared.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic value of echocardiographic indicators,NT-proBNP,and HBDH in sepsis with concurrent heart failure.Results The left ventricular ejection fractions(LVEF),stroke volume variation(SVV),cardiac output(CO),fraction shortening(FS),and mitral early diastolic inflow velocity/mitral late diastolic inflow velocity(E/A)values of the heart failure group were significantly lower than those of the non-heart failure group,with statistically significant differences(P<0.05).The NT-proBNP,HBDH,interleukin(IL-6),tumor necrosis factor(TNF-α),procalcitonin(PCT)values,APACHEⅡscores,and Sofa scores of the heart failure group were significantly higher than those of the non-heart failure group,with statistically significant differences(P<0.05).There was no statistically significant difference in C-reactive protein(CRP)levels between the two groups(P>0.05).For the 36 patients with sepsis and concurrent heart function damage,the NT-proBNP values were negatively correlated with LVEF,SVV,CO,FS,and E/A(P<0.05);and HBDH values were negatively correlated with LVEF and FS(P<0.05).The sensitivities of NT-proBNP,HBDH,and NT-proBNP+HBDH in diagnosing sepsis with concurrent heart failure were 76.17%,48.52%,and 92.41%,respectively,and the specificities were 91.90%,89.20%,and 84.58%,respectively.The area under the ROC curve(AUC)were 0.893,0.757,and 0.944,respectively.Conclus

关 键 词：脓毒症 心功能不全 氨基末端脑钠肽前体 羟丁酸脱氢酶 诊断 老年 

分 类 号：R541.6[医药卫生—心血管疾病] R592[医药卫生—内科学]