摘要
目的:探讨血清高敏肌钙蛋白(hs-cTnT)在评估脓毒症患者心肌损伤严重程度及预测脓毒症预后的价值。方法:采用前瞻性研究方法,选择2016-01—2017-03期间辽宁省人民医院急诊重症监护病房(EICU)的脓毒症患者112例,将患者分为脓毒症组30例、严重脓毒症组47例和脓毒性休克组35例,以入院第28天转归将每组再次分为死亡组和存活组共6个亚组,以同期健康人20例作为对照组。记录当日急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。于住院第1、2、3、5、7天检测血清hs-cTnT水平。将各组间变量进行分析比较,使用受试者工作特征(ROC)曲线评价血hs-cTnT对脓毒症预后的预测价值。结果:患者血清hs-cTnT浓度与脓毒症密切相关,脓毒症患者较对照组hs-cTnT显著升高,随着脓毒症严重程度的增加hs-cTnT水平逐渐升高,各组间差异有统计学意义(P<0.05)。病情程度相同情况下,死亡组hs-cTnT水平高于存活组,随着时间推移死亡组hs-cTnT水平逐渐上升,存活组血清hs-cTnT水平呈明显下降趋势,且两组间血清hs-cTnT动态水平比较差异均有统计学意义(P<0.05)。在住院第1、2、3、5、7天,hs-cTnT预测预后的ROC曲线下面积(AUC)分别为0.750、0.870、0.897、0.927、0.953(P<0.05),APACHEⅡ预测预后的AUC分别为0.859、0.962、0.971、0.974、0.974(P<0.05)。结论:血清hs-cTnT可以作为脓毒症心肌损伤预警指标,在一定程度上反应患者心肌损伤的严重程度;动态监测hs-cTnT水平的变化趋势更有助于评估脓毒血症患者心肌损伤的程度和病情的进展;不建议单独使用hs-cTnT作为预测脓毒症预后的指标。
Objective：：To evaluate the severity of myocardial injury in patients with sepsis and the prognostic value of sepsis in patients with sepsis.Method：A prospective study was conducted.From January 2016 to June2017,112 patients with sepsis in emergency intensive care unit（EICU）of the people＇s hospital of liaoning province were selected.Patients were divided into sepsis group（n=30）,severe sepsis group（n=47）and septic shock group（n=35）,then each group was divided into death group and survival group according to the 28-day prognosis.HscTnT levels were measured on the 1 st,2 nd,3 rd,5 th and 7 th day after admission,and the acute physiology and chronic health evaluationⅡ（APACHEⅡ）score were monitored at admission to ICU.At the same time,20 healthy people were enrolled as control group.The variables of each group were analyzed and compared.To evaluate the prognostic value of hs-cTnT in the prognosis of sepsis using the ROC curve.Result：Plasma hs-cTnT concentration were significantly related to sepsis in ICU.plasma hs-cTnT was obviously higher in sepsis group then control group.The level of hs-cTnT increased gradually with the severity of sepsis（P〈0.05）.When the severity of sepsis is the same,the death group hs-cTnT level was higher than the survival group,the hs-cTnT level of the death group increased gradually over time,the hs-cTnT level showed a significant decrease in the survival group.The difference of hs-cTnT dynamic level between the two groups was statistically significant（P〈0.05）.The area（AUC）of the ROC curve was 0.750、0.870、0.897、0.927 and 0.953（P〈0.05）,respectively,in the 1 st,2 nd,3 rd,5 th and 7 th days of hs-cTnT prediction.The area（AUC）of the ROC curve was 0.859、0.962、0.971、0.974 and0.974（P〈0.05）,respectively,in the 1 st,2 nd,3 rd,5 th and 7 th days of APACHEⅡ prediction.Conclusion：Hs-cTnT can reflect the severity of myocardial injury to a certain extent,it can be used as a warning indicator for myocardial injury in sepsis.Dyna
作者
周淑清
沈涛
ZHOU Shuqing;SHEN Tao(Department of Emergency,the People＇s Hospital of Liaoning,Shenyang,110016,China;Department of Auxiliary Diagnoses,The 463th Hospital of PLA)
出处
《临床急诊杂志》
CAS
2018年第9期607-610,共4页
Journal of Clinical Emergency
基金
辽宁省科学技术基金(No:201602759)
关键词
脓毒症
高敏肌钙蛋白
急诊重症监护病房
预测价值
sepsis
highly sensitive cardiac troponin T
emergency intensive care unit（EICU）
predictive value
