外周炎症标志物对脓毒症并发心肌损伤的早期预测价值  

Early predictive value of peripheral inflammatory markers for sepsis complicated with myocardial injury

作　　者：徐政 毛和飞 邱灿虎 XU Zheng;MAO Hefei;QIU Canhu(Department of Critical Care Medicine,Jiangshan People's Hospital,Jiangshan 324100,China)

机构地区：[1]江山市人民医院重症医学科,324100

出　　处：《心电与循环》2025年第1期46-50,55,共6页Journal of Electrocardiology and Circulation

基　　金：江山市科技计划指导性项目(JS2022D046)。

摘　　要：目的探讨外周炎症标志物对脓毒症并发心肌损伤的早期预测价值。方法回顾性选取2021年1月至2022年12月江山市人民医院收治的134例脓毒症患者为研究对象,根据入院后72 h心肌肌钙蛋白T(c Tn T)水平分为心肌损伤(≥0.3 ng/m L)组63例和非心肌损伤(<0.3 ng/m L)组71例,比较两组患者临床资料,采用多因素logistic回归分析脓毒症并发心肌损伤的影响因素,采用ROC曲线分析外周炎症标志物[包括中性粒细胞计数与淋巴细胞计数比值(NLR)、血小板计数与淋巴细胞计数比值(PLR)、血小板计数与中性粒细胞计数比值(PNR)]对脓毒症并发心肌损伤的预测效能,采用Pearson相关分析外周炎症标志物与c Tn T的相关性。结果心肌损伤组患者心率、血乳酸、中性粒细胞计数、C反应蛋白、降钙素原、NLR均高于非心肌损伤组,平均动脉压(MAP)、血小板计数、PLR、PNR均低于非心肌损伤组,差异均有统计学意义(均P<0.05)。心率(OR=1.025)、MAP(OR=0.959)、血乳酸(OR=0.661)、NLR(OR=1.191)、PLR(OR=0.984)、PNR(OR=0.801)均是脓毒症并发心肌损伤的独立影响因素(均P<0.05)。NLR、PLR、PNR预测脓毒症并发心肌损伤的AUC分别为0.765、0.789、0.808,截断值分别为17.17、193.63、13.37,灵敏度分别为0.761、0.747、0.732,特异度分别为0.698、0.778、0.810。脓毒症并发心肌损伤患者NLR与c Tn T呈正相关(r=0.321,P=0.010),PLR、PNR与c Tn T均呈负相关(r=-0.461、-0.597,均P<0.01)。结论NLR、PLR、PNR与脓毒症患者发生心肌损伤以及严重程度关系密切,可作为早期预测指标。Objective To investigate the early predictive value of peripheral inflammatory markers for sepsis complicated with myocardial injury.Methods A total of 134 patients with sepsis admitted to Jiangshan People's Hospital from January 2021 to December 2022 were retrospectively selected as the study objects.According to the myocardial troponin T(cTnT)level 72 h after admission,63 patients were divided into myocardial injury group(≥0.3 ng/mL)and 71 patients were divided into non-myocardial injury group(<0.3 ng/mL).The clinical data of the two groups were compared,and the influencing factors for sepsis complicated with myocardial injury were analyzed by multivariate logistic regression.ROC curve was used to analyze the predictive efficacy of peripheral inflammatory markers,including neutrophil count to lymphocyte count ratio(NLR),platelet count to lymphocyte count ratio(PLR),and platelet count to neutrophil count ratio(PNR),for sepsis complicated with myocardial injury.Pearson correlation was used to analyze the correlation between peripheral inflammatory markers and cTnT.Results The heart rate,blood lactic acid,neutrophil count,C-reactive protein,procalcitonin and NLR in the myocardial injury group were significantly higher than those of the non-myocardial injury group(all P<0.05),while the mean arterial pressure(MAP),platelet count,PLR and PNR levels were significantly lower than those of the non-myocardial injury group(all P<0.05).Heart rate(OR=1.025),MAP(OR=0.959),blood lactic acid(OR=0.661),NLR(OR=1.191),PLR(OR=0.984),and PNR(OR=0.801)were independent influencing factors for myocardial injury in sepsis(all P<0.05).The AUCs of NLR,PLR and PNR for predicting myocardial injury in sepsis were 0.765,0.789 and 0.808,respectively,with cut-off values of 17.17,193.63 and 13.37,respectively,sensitivity of 0.761,0.747 and 0.732,respectively,and specificity of 0.698,0.778 and 0.810,respectively.NLR was positively correlated with cTnT in sepsis patients with myocardial injury(r=0.321,P=0.010),while PLR and PNR were negatively

关 键 词：脓毒症 心肌损伤 血小板计数与中性粒细胞计数比值 血小板计数与淋巴细胞计数比值 中性粒细胞计数与淋巴细胞计数比值 预测价值 

分 类 号：R73[医药卫生—肿瘤]