肌钙蛋白I、B型脑钠肽对脓毒症性心肌功能障碍发生的预测与预后评估价值

Predictable and prognostic value of cardiac troponin I and brain natriuretic peptide in patients with sepsis-associated myocardial dysfunction

目的探讨肌钙蛋白I(c Tn I)、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c Tn I、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 c Tn I、24 h c Tn I、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 c Tn I、24 h c Tn I、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 c Tn I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 c Tn I、24 h c Tn I、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2 000 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、c Tn I水平可预测心肌功能障碍发生,并有利于判断预后。

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.