摘要
目的探讨心脏超声联合心脏标志物在脓毒症心功能不全的临床诊断价值。方法采用前瞻性临床观察研究,收集2016年10月至2018年2月依次入住石河子大学第一附属医院重症医学科94例脓毒症患者,依据排除标准排除14例脓毒症患者,余80例于入科1~3d完善心脏超声,入科1d采集外周血检测氨基末端脑钠肽前体(NTproBNP)、肌钙蛋白(IcTNI)、肌酸激酶同工酶(CK-MB)、糖原磷酸化酶BB型同工酶(GPBB)、血清心型脂肪酸结合蛋白(H-FABP)。根据有无心功能不全将脓毒症患者分为脓毒症心功能正常组32例和脓毒症心功能不全组48例,统计分析心脏超声和心脏标志物结果,采用多因素Logistic回归分析筛选出对脓毒症心功能不全的发生起主要影响作用的因素。结果脓毒症心功能不全发生的影响因素分别为:左心室舒张末期容积(EDV)、每搏输出量(SV)、左室射血分数(LVEF)、每分输出量(CO)、短轴缩短率(FS)、等容舒张时间(IVRT)、三尖瓣口舒张晚期血流速度(A’)、右室游离壁三尖瓣环收缩期运动速度峰值(Sm)、NT-proBNP。各个指标ROC曲线下面积大小:NT-proBNP(0.915)、A’(0.908)> SV(0.779)、IVRT(0.775)> CO(0.754)、EF(0.753)> Sm(0.738)、FS(0.728)> EDV(0.636)。NT-proBNP与A’进行系列试验,阳性似然比在各项联合诊断试验中最高,为80.1,灵敏度为78.53%,特异度为99.02%,阳性预测值为99.29%,阴性预测值为72.66%,一致率为86.02%。NT-proBNP、A’与SV进行平行试验,阴性似然比在各项联合诊断试验中最小,为0.008,灵敏度为99.44%,特异度69.61%,阳性预测值为85.02%,阴性预测值为98.61%,一致率为88.53%。结论 (1)NT-proBNP、A’进行系列试验可以作为脓毒症心功能不全的诊断试验;(2)NT-proBNP、A’、SV进行平行试验可作为排除脓毒症心功能不全的诊断试验。
Objective To investigate the diagnostic value of echocardiography combined with cardiac markers in patients with sepsis-induced cardiac insufficiency.Methods A prospective clinical observational study was conducted.Totally 94 patients who were admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Shihezi University from October 2016 to February 2018 were selected;14 septic patients were excluded according to the exclusion criteria.The remaining 80 patients with sepsis underwent transthoracic echocardiography on 1st day-3rd day.Level of NT-proBNP,cTNI,CK-MB,GPBB and H-FABP were detected on 1st day.The 80 patients were divided into sepsis-induced myocardial dysfunction group and sepsis without myocardial dysfunction group according to whether of not cardiac dysfunction occurred.Data of echocardiography and cardiac markers were statistically analyzed.Results The result of Logistic regression analysis showed that the main factors affecting the occurrence of sepsis cardiac dysfunction were:EDV,SV,EF,CO,FS,IVRT,A’,SM and NT-proBNP.The area under the ROC curve was:NT-proBNP(0.915),A’(0.908)>SV(0.779),IVRT(0.775)>EF(0.753),CO(0.754)>Sm(0.738),FS(0.728)>EDV(0.636).When NT-proBNP and A’were tested in series,the positive likelihood ratio was the highest in all joint diagnostic tests,the value being 80.1,sensitivity 78.53%,specificity 99.02%;positive predictive value 99.29%;negative predictive value was 72.66%,and the agreement rate was 86.02%.When NT-proBNP,A'and SV were tested in parallel,the negative likelihood ratio was the smallest in each joint diagnostic test,the value being 0.008,with a sensitivity of 99.44%,a specificity of 69.61%,and a positive predictive value of 85.02%.Negative predictive value was 98.61%and the agreement rate was 88.53%.Conclusion Series tests of NT-proBNP and A'can be used as a diagnostic test for sepsis-induced cardiac insufficiency.Parallel test of NT-proBNP,A'and SV be used as a diagnostic test to exclude sepsis-induced cardiac insufficiency.
作者
陈素梅
古丽巴哈尔
田培刚
程青虹
翁国鹏
王永春
CHEN Su-mei;Gulibahaer;TIAN Pei-gang;CHENG Qing-hong;WENG Guo-peng;WANG Yong-chun(The Second department of Critical Care Medicine,First Affiliated Hospital of the Medical College of Shihe University,Shihezi 832000,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2020年第6期481-486,共6页
Chinese Journal of Practical Internal Medicine
基金
兵团科技攻关与成果转化计划项目(2016AD003)。
关键词
脓毒症
心功能不全
心脏超声
心脏标志物
sepsis
cardiac insufficiency
echocardiography
cardiac markers
