中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
9期
1016-1021
,共6页
李振华%董磊%王国兴%谢苗荣
李振華%董磊%王國興%謝苗榮
리진화%동뢰%왕국흥%사묘영
重症脓毒症%脓毒症休克%脑利钠肽%肌钙蛋白T%肌钙蛋白I%心肌损伤%射血分数%预后
重癥膿毒癥%膿毒癥休剋%腦利鈉肽%肌鈣蛋白T%肌鈣蛋白I%心肌損傷%射血分數%預後
중증농독증%농독증휴극%뇌리납태%기개단백T%기개단백I%심기손상%사혈분수%예후
Severe sepsis%Septic shock%B-type natriuretic peptide%Troponin T%Troponin I%Cardiac injury%Ejection fraction%Prognosis
目的 比较重症脓毒症和脓毒症休克时脑利钠肽(BNP)、肌钙蛋白T(TnT)及肌钙蛋白I (TnI)水平的差异,探索重症脓毒症及脓毒症休克时心脏损害的程度及检测BNP、TnT及TnI的意义.方法 回顾性分析2005年至2010年在北京首都医科大学附属北京友谊医院住院诊断为重症脓毒症和脓毒症休克的患者共98例,住院期间行超声心动图检查,住院第1、3、7天检测BNP,TnT及TnI.其中重症脓毒症患者57例,脓毒症休克患者41例.重症脓毒症组(S)分为心功能正常组(Sn)、心功能异常组(Sa)、死亡组(Sd)和存活组(Ss)四个亚组,脓毒症休克组(SS)分为心功能正常组(SSn)、心功能异常组(SSa)、死亡组(SSd)及存活组(SSs)四个亚组.x2检验判断各组病死率的是否存在统计学差异,SNK-q比较各组间血浆BNP、TnT、TnI水平是否具有统计学差异,以直线相关判断上述指标与EF值的相关性,受试者工作曲线(ROC)评估上述指标与预后的关系.结果 (1)S组和SS组的BNP和TnI水平差异无统计学意义,但SS组的TnT水平明显高于S组(P=0.001)；(2) Sa组BNP、TnT及TnI显著高于Sn组,Sd组BNP明显高于Ss组(P=0.001); (3) SSa组BNP、TnT及TnI明显高于SSn组,SSd组BNP明显高于SSs组(第1天P=0.001,第3天P＝0.001,第7天P=0.016)；(4) SSn组的TnT、TnI显著高于Sn组,且SSn组第1、3、7天的BNP均明显高于Sn组(第1天P=0.006,第3天P=0.006,第1天P=0.001); (5) Sd及SSd组的BNP均明显高于Ss组和SSs组；(6)S组与SS组中心功能异常组的病死率更高,差异具有统计学意义(Sa与Sn组比较,P＜0.05,SSa与SSn组比较,P＜0.05)；(7) Sd和SSd患者入院时的EF值和BNP水平呈负相关(r=-0.603,P＜0.01),入院72 h内BNP水平＞0.39 ng/ml可作为预测死亡的临界点,其敏感度92.9％,特异性80.8％.结论 血浆BNP、TnT及TnI水平可在一定程度上反应患者心脏损伤的严重程度,BNP、TnT及TnI水平明显升高者预后较差；BNP可作为预测脓毒症心脏损伤患者预后的指标.
目的 比較重癥膿毒癥和膿毒癥休剋時腦利鈉肽(BNP)、肌鈣蛋白T(TnT)及肌鈣蛋白I (TnI)水平的差異,探索重癥膿毒癥及膿毒癥休剋時心髒損害的程度及檢測BNP、TnT及TnI的意義.方法 迴顧性分析2005年至2010年在北京首都醫科大學附屬北京友誼醫院住院診斷為重癥膿毒癥和膿毒癥休剋的患者共98例,住院期間行超聲心動圖檢查,住院第1、3、7天檢測BNP,TnT及TnI.其中重癥膿毒癥患者57例,膿毒癥休剋患者41例.重癥膿毒癥組(S)分為心功能正常組(Sn)、心功能異常組(Sa)、死亡組(Sd)和存活組(Ss)四箇亞組,膿毒癥休剋組(SS)分為心功能正常組(SSn)、心功能異常組(SSa)、死亡組(SSd)及存活組(SSs)四箇亞組.x2檢驗判斷各組病死率的是否存在統計學差異,SNK-q比較各組間血漿BNP、TnT、TnI水平是否具有統計學差異,以直線相關判斷上述指標與EF值的相關性,受試者工作麯線(ROC)評估上述指標與預後的關繫.結果 (1)S組和SS組的BNP和TnI水平差異無統計學意義,但SS組的TnT水平明顯高于S組(P=0.001)；(2) Sa組BNP、TnT及TnI顯著高于Sn組,Sd組BNP明顯高于Ss組(P=0.001); (3) SSa組BNP、TnT及TnI明顯高于SSn組,SSd組BNP明顯高于SSs組(第1天P=0.001,第3天P＝0.001,第7天P=0.016)；(4) SSn組的TnT、TnI顯著高于Sn組,且SSn組第1、3、7天的BNP均明顯高于Sn組(第1天P=0.006,第3天P=0.006,第1天P=0.001); (5) Sd及SSd組的BNP均明顯高于Ss組和SSs組；(6)S組與SS組中心功能異常組的病死率更高,差異具有統計學意義(Sa與Sn組比較,P＜0.05,SSa與SSn組比較,P＜0.05)；(7) Sd和SSd患者入院時的EF值和BNP水平呈負相關(r=-0.603,P＜0.01),入院72 h內BNP水平＞0.39 ng/ml可作為預測死亡的臨界點,其敏感度92.9％,特異性80.8％.結論 血漿BNP、TnT及TnI水平可在一定程度上反應患者心髒損傷的嚴重程度,BNP、TnT及TnI水平明顯升高者預後較差；BNP可作為預測膿毒癥心髒損傷患者預後的指標.
목적 비교중증농독증화농독증휴극시뇌리납태(BNP)、기개단백T(TnT)급기개단백I (TnI)수평적차이,탐색중증농독증급농독증휴극시심장손해적정도급검측BNP、TnT급TnI적의의.방법 회고성분석2005년지2010년재북경수도의과대학부속북경우의의원주원진단위중증농독증화농독증휴극적환자공98례,주원기간행초성심동도검사,주원제1、3、7천검측BNP,TnT급TnI.기중중증농독증환자57례,농독증휴극환자41례.중증농독증조(S)분위심공능정상조(Sn)、심공능이상조(Sa)、사망조(Sd)화존활조(Ss)사개아조,농독증휴극조(SS)분위심공능정상조(SSn)、심공능이상조(SSa)、사망조(SSd)급존활조(SSs)사개아조.x2검험판단각조병사솔적시부존재통계학차이,SNK-q비교각조간혈장BNP、TnT、TnI수평시부구유통계학차이,이직선상관판단상술지표여EF치적상관성,수시자공작곡선(ROC)평고상술지표여예후적관계.결과 (1)S조화SS조적BNP화TnI수평차이무통계학의의,단SS조적TnT수평명현고우S조(P=0.001)；(2) Sa조BNP、TnT급TnI현저고우Sn조,Sd조BNP명현고우Ss조(P=0.001); (3) SSa조BNP、TnT급TnI명현고우SSn조,SSd조BNP명현고우SSs조(제1천P=0.001,제3천P＝0.001,제7천P=0.016)；(4) SSn조적TnT、TnI현저고우Sn조,차SSn조제1、3、7천적BNP균명현고우Sn조(제1천P=0.006,제3천P=0.006,제1천P=0.001); (5) Sd급SSd조적BNP균명현고우Ss조화SSs조；(6)S조여SS조중심공능이상조적병사솔경고,차이구유통계학의의(Sa여Sn조비교,P＜0.05,SSa여SSn조비교,P＜0.05)；(7) Sd화SSd환자입원시적EF치화BNP수평정부상관(r=-0.603,P＜0.01),입원72 h내BNP수평＞0.39 ng/ml가작위예측사망적림계점,기민감도92.9％,특이성80.8％.결론 혈장BNP、TnT급TnI수평가재일정정도상반응환자심장손상적엄중정도,BNP、TnT급TnI수평명현승고자예후교차；BNP가작위예측농독증심장손상환자예후적지표.
Objective To investigate the degree of cardiac function impairment, and clinical implications of BNP,TnT and TnI in patients with severe sepsis and septic shock retrospectively by comparing the differences in levels of BNP,TnT and TnI among those patients.Methods From December 2005 through December 2010,98 patients admitted with severe sepsis ( n =57 ) or septic shock ( n =41 )were enrolled to be studied.The inclusion criteria were ( 1 ) echocardiography was performed; (2) levels of serum BNP,TnT and TnI were determined on the 1st day,3rd day and 7th days after admission.These 98 patients were divided into 2 major groups:severe sepsis group (S) and septic shock group (SS) ; and each major group was further divided into 4 subgroups,including severe sepsis normal cardiac function (Sn) ;severe sepsis abnormal cardiac function (Sa); severe sepsis death (Sd),severe sepsis survival (Ss);septic shock normal cardiac function ( SSn ),septic shock abnormal cardiac function ( Ssa ),septic shock death (SSd) and septic shock survival (SSs).Then comparisonsof the plasma levels of BNP,TnT and TnI were carried out among groups respectively.The morality difference between groups S vs SS,and Savs Sn,and Ssa vs SSn were compared by using the Chi-square Test.The differences in BNP,TnT and Tnl between groups were compared by SNK-q test.Correlation between ejection fraction (EF) value and those biomarkers was calculated by Pearson correlation coefficient.The relationship between those biomarkers and outcomes was determined by using receiver operating characteristic curve (ROC). Results ( 1 ) There were no significant differences in levels of BNP and TnI between group S and SS,but TnT level in patients of SS group was significantly higher than that in S group ( P =0.001 ).( 2 ) TnT,BNP,Tnl levels in Sa group were significantly higher than those in group Sn; and BNP level in group SSd was significantly higher than that in SSs group (P =0.001 ).(3) BNP,TnT and TnI levels in group Ssa were significantly higher than those in group SSn,and BNP level in SSd group was significantly higher than that in SSs ( Pday 1 =0.001,Pday3 =0.001,Pday7 =0.016). (4) TnT and TnI levels in group SSn were significantly higher than those in group Sn,and BNP levels in SSn group on the 1st day,3rd day and 7th days were significantly higher than those in Sn group (Pday1 =0.006,Pday3 =0.006,Pday7 =0.001).(5) Higher mortality rates in group S and group SS were associated with higher BNP level.(6) Group Sa and Ssa had higher mortality rate than group Sn and SSn ( Sa vs.Sn,P ＜ 0.05,Ssa vs.SSn,P ＜ 0.05).(7) EF and serum BNP level in group Sd and group SSd at admission had negative correlation ( r =- 0.603,P ＜ 0.01 ),and BNP level higher than 0.39 ng/ml within the first 72 hours after admission may be an independent prognostic factor of mortality ( sensitivity 92.9％,specificity 80.8％ ).Conclusions Plasma BNP,TnT,TnI levels have a positive correlation with cardiac function impairment. Significant elevation in BNP,TnT,and TnI levels indicates sever cardiac dysfunction and thus a worsening prognosis is expected.Serum BNP could be a useful diagnostic indicator for the septic patients with cardiac dysfunction.
