心肌标记物在脓毒症患者预后评估中的意义

Myocardialmarkers for evaluation of prognosis in patients with sepsis

关键词:  脓毒症  脂联素  脑利钠肽  肌钙蛋白-I  预后评估

Key words:  sepsis  adiponectin  brain natriuretic peptide  troponin-I  prognostic evaluation

摘要:

目的 探讨心肌标记物脂联素（adiponectin, APN）、脑利钠肽（brain natriuretic peptide, BNP）和肌钙蛋白-I（troponin-I, cTn-I）在脓毒症患者预后评估中的意义。方法 采用前瞻性队列研究，纳入2016—2018年4月入住同济大学附属同济医院EICU且符合入组标准的脓毒症患者125例。收集患者详细病史资料，监测患者入院当天APN、BNP、cTn-I、Lac、IL-6、IL-8及TNF-α水平及入院后第1、3、7天心肌标记物动态监测，以住院期间死亡作为观察终点。结果 125例脓毒症患者中存活94例，死亡31例。生存组与死亡组在呼吸频率、心率、平均动脉压、氧合指数、ICU住院天数之间差异有统计学意义（P＜0.05）。死亡组入院时危重评分（APACHE Ⅱ、SOFA、qSOFA）、BNP（第3、7天）、cTn-I（第7天）、IL-6及TNF-α水平明显高于存活组（P＜0.05），而APN水平则明显低于存活组（P=0.012）。APN水平与IL-6、TNF-α、BNP、cTn-I之间均存在显著负相关性（P＜0.05）。生存预后曲线显示，入院时BNP＞1200pg/mL、cTn-I＞0.11ng/mL、APN＜1016.05pg/mL，其住院期间死亡风险明显增加。结论 心肌标记物及其动态监测对脓毒症患者预后评估有一定的临床价值。APN水平升高对脓毒症患者是保护因素，监测血APN水平对脓毒症严重程度及预后判断有一定的指导意义。

Abstract:

Objective To investigate the application of myocardial injury markers in evaluation of prognosis in patients with sepsis. Methods In this prospective cohort study, 125 patients with sepsis admitted in EICU of Tongji University Affiliated Tongji University from January 2016 to April 2018 were recruited. Plasma adiponectin (APN), IL-6, IL-8, and TNF-α levels were detected on d1 of admission; while plasma brain natriuretic peptide (BNP) , troponin-I (cTn-I), and Lac were detected on d1, d3 and d7 of admission in all patients. Death during hospitalization was the endpoint of observation. Results Among 125 septic patients, 94 survived and 31 died. There were significant differences between the survival group and the death group in respiratory rate, heart rate, mean arterial pressure, oxygenation index, and length of ICU stay (P＜0.05). In the death group, the d1 critical scores (APACHE Ⅱ, SOFA, qSOFA), BNP (d3, d7), cTn-I (d7), IL-6, and TNF-α levels were significantly higher (P＜0.05); while plasma APN levels were significantly lower in death group (P=0.012). There was a negative correlation between APN levels and inflammatory factors, BNP, and cTn-I (P＜0.05). The survival curve showed that when BNP＞1200pg/mL, cTn-I＞0.11ng/mL and APN＜1016.05pg/mL at d1, the risk of death increased significantly during hospitalization. Conclusion The dynamic changes of plasma BNP and cTn-I levels have certain clinical value in the evaluation of prognosis of patients with sepsis. The increase of APN level is a protective factor in patients with sepsis, which can be used for monitoring disease severity and prognosis of septic patients.