CAJ | 학술논문

目的：探讨肌钙蛋白I （cTnI）、B型脑钠肽（BNP）在脓毒症性心肌功能障碍患者中预测发生和评估预后的价值。方法将76例脓毒症患者根据左心室射血分数是否＜50%，分为心肌功能障碍组和心功能正常组；并根据28 d是否存活将心肌功能障碍组分为存活亚组和死亡亚组，利用受试者工作者特征（ROC）曲线观察入ICU 1 h、24 h的cTnI、BNP预测心肌功能障碍发生以及预后评估意义。结果心肌功能障碍组的1 h cTnI、24 h cTnI、1 h BNP、24 h BNP均高于心功能正常组，差异有统计学意义（均P＜0.05）。1 h cTnI、24 h cTnI、1 h BNP、24 h BNP预测脓毒症心肌功能障碍发生的曲线下面积分别为0.78、0.72、0.73、0.76，敏感性与特异性均较高，其中1 h cTnI预测效能最高，界值为0.73 ng/ml，敏感性为0.71，特异性为0.74。1 h cTnI、24 h cTnI、1 h BNP、24 h BNP评估脓毒症心肌功能障碍患者28 d死亡的曲线下面积分别为0.81、0.87、0.86、0.90，特异性、敏感性均较高。其中24 h BNP评估28 d死亡的效能最高，界值为2000 pg/ml，敏感性为0.85，特异性为0.83。结论脓毒症时早期监测BNP、cTnI水平可预测心肌功能障碍发生，并有利于判断预后。
목적：탐토기개단백I （cTnI）、B형뇌납태（BNP）재농독증성심기공능장애환자중예측발생화평고예후적개치。방법장76례농독증환자근거좌심실사혈분수시부＜50%，분위심기공능장애조화심공능정상조；병근거28 d시부존활장심기공능장애조분위존활아조화사망아조，이용수시자공작자특정（ROC）곡선관찰입ICU 1 h、24 h적cTnI、BNP예측심기공능장애발생이급예후평고의의。결과심기공능장애조적1 h cTnI、24 h cTnI、1 h BNP、24 h BNP균고우심공능정상조，차이유통계학의의（균P＜0.05）。1 h cTnI、24 h cTnI、1 h BNP、24 h BNP예측농독증심기공능장애발생적곡선하면적분별위0.78、0.72、0.73、0.76，민감성여특이성균교고，기중1 h cTnI예측효능최고，계치위0.73 ng/ml，민감성위0.71，특이성위0.74。1 h cTnI、24 h cTnI、1 h BNP、24 h BNP평고농독증심기공능장애환자28 d사망적곡선하면적분별위0.81、0.87、0.86、0.90，특이성、민감성균교고。기중24 h BNP평고28 d사망적효능최고，계치위2000 pg/ml，민감성위0.85，특이성위0.83。결론농독증시조기감측BNP、cTnI수평가예측심기공능장애발생，병유리우판단예후。
Objective To evaluate the predictable and prognostic value of cardiac troponin I and brain natriuretic peptide in patients with sepsis-associated myocardial dysfunction (SMD). Methods 76 patients with sepsis were divided into the SMD group and the normal cardiac function group in relation to left ventricle ejection fraction (<50%). Moreover patients with SMD were divided into death subgroup and survival subgroup according to 28-day mortality. Receiver operating characteristic curve (ROC) was constructed to observe the predictable and prognostic value of cTnI and BNP on the first 1 hour and 24 hour after ICU admission. Results The levels of the 1 h-cTnI, 24 h-cTnI, 1 h-BNP and 24 h-BNP in SMD group were significantly higher than them in normal cardiac function group (all P<0.05). The area under the curve of 1 h-cTnI, 24 h-cTnI, 1 h-BNP and 24 h-BNP were 0.78, 0.72, 0.73, 0.76 respectively in predicting the occurrence of SMD with high sensibility and specificity. With a cutoff value of 0.73 ng/ml, 1 h-cTnI was the best marker to predict SMD occurrence (sensibility=71%, specificity=74%). The area under the curve (AUC) of 1 h-cTnI, 24 h-cTnI, 1 h-BNP and 24 h-BNP were 0.81, 0.87, 0.86, 0.90 respectively in predicting 28-day mortality, with high sensibility and specificity. With a cutoff value of 2 000 pg/ml, 24 h-BNP was the best marker to predict 28-day mortality (sensibility=71%, specificity=74%). Conclusion Early detection of BNP and cTnI levels may help to early predict myocardial dysfunction in patients with sepsis and evaluate their prognoses.