心型脂肪酸结合蛋白和可溶性CD14亚型在丹参川芎嗪治疗脓毒症心肌损伤中的变化

The changes and significance of heart-type fatty acid-binding protein and soluble CD14-st in the treatment of Danshen Chuanxiongqin in sepsis patients with myocardial injury

目的:观察心型脂肪酸结合蛋白(H-FABP)和可溶性CD14亚型(Presepsin)在丹参川芎嗪治疗脓毒症心肌损伤患者中的变化及意义。方法:114例脓毒症心肌损伤患者随机分成对照组和治疗组,对照组给予常规治疗,治疗组在对照组基础上加丹参川芎嗪。患者治疗前及治疗6 h、3 d,检测H-FABP、Presepsin、肌钙蛋白I(cTnI)及N-末端脑钠肽前体(NT-proBNP)的变化,观察治疗前后LVEF、SOFA评分、主要心脏不良事件(MACE)发生率及28 d病死率。结果:治疗6 h,治疗组H-FABP、Presepsin、cTnI和NT-proBNP低于对照组(P<0.05),两组H-FABP、cTnI和NT-proBNP高于治疗前,Presepsin低于治疗前(P<0.05)。治疗3 d,两组cTnI和NT-proBNP较治疗6 h升高,Presepsin较治疗6 h降低(P<0.05),对照组Presepsin、cTnI和NT-proBNP高于治疗组(P<0.05)。治疗组治疗后SOFA评分、LVEF、累计MACE发生率和28 d病死率低于对照组(P<0.05)。患者H-FABP与SOFA评分呈正相关(P<0.05)。结论:丹参川芎嗪能降低患者H-FABP、Presepsin、cTnI和NT-proBNP,改善LVEF,降低28 d病死率,减少MACE发生,为指导临床治疗提供依据。

Objective To investigate the changes and significance of heart-type fatty acid-binding protein （H-FABP） and soluble CD14-st （Presepsin） in the treatment of Danshen Chuanxiongqin in sepsis patients with myocardial injury. Methods The 114 sepsis patients with myocardial injury were divided into two groups： the control group （routine treatment） and the therapy group （treated by Danshen Chuanxiongqin based on routine treatment）. Before treatment, 6 hours and 3 days after treatment, H-FABP, Presepsin, cardiac troponin I （cTnI） and N terminal probrain natriuretic （NT-proBNP） of patients were detected, and the change of LVEF, SOFA scores, cumulative incidence of major adverse cardiac events （MACE） and 28-day mortality were recorded. Results At 6 hours after treatment, the H-FABP, Presepsin, cTnI and NT-proBNP in therapy group were lower than those in the control group （P 〈 0.05）. Higher levels of H-FABP, cTnI and NT-proBNP were observed after treatment, however presepsin was lower than that before treatment （P 〈 0.05）. On 3 days after treatment, cTnI and NT-proBNP were higher, but presepsin was lower in the two groups than those at 6 hours after treatment （P 〈 0.05）. Presepsin, cTnl and NT-proBNP in the control group were higher than those in the therapy group （P 〈 0.05）. SOFA score, LVEF, 28-day mortality and cumulative incidence of MACE after treatment in the therapy group were lower than those in the control group （P 〈 0.05）. H-FABP in patients were positively correlated with SOFA score. Conclusion Danshen Chuanxiongqin could decrease H-FABP, Presepsin, eTnI and NT-proBNP, improve the LVEF, reduce 28-day mortality, and decrease the incidence of MACE, which was worthy of clinical popularizing and application.