脓毒症患儿心肌损伤与血乳酸的关系

Relationship between myocardial injury and blood lactic acid in children with sepsis

目的:通过测定脓毒症患儿血中肌红蛋白(Myo)、肌钙蛋白(cTnI)、N-末端脑钠素原(NT-proBNP)水平,结合动脉血乳酸的结果,研究脓毒症患儿心肌损伤与血乳酸的关系。方法:收集2012-01-2014-12收住我院PICU的325例脓毒症患儿为研究对象,收集Lac、Myo、BNP、cTnI等相关指标数据。结果:严重脓毒症组和脓毒症休克组血Myo、BNP、cTnI、Lac水平均显著高于普通脓毒症组(P<0.05);Lac>1mmol/L组血Myo、BNP、cTnI水平均显著高于Lac≤1mmol/L组和1mmol/L<Lac≤4mmol/L组(P<0.01);血Lac水平与血Myo、BNP、cTnI水平呈正相关(r=0.364、0.394、0.357,均P<0.001);合并心肌损伤组患儿入院时、住院3d血Lac水平均显著高于未合并心肌损伤组(均P<0.001)。结论:动脉血乳酸作为衡量脓毒症患儿病情危重程度、预后、评估治疗效果的指标,与心肌损伤有密切的关联性,心肌损伤可能影响脓毒症患儿乳酸清除。

Objective：The purpose of the study was to explore the correlation between myocardial injury and blood lactic acid in children with sepsis by decting the levels of Myoglobin （Myo）, Troponin （cTnI）, N-terminal brain natriuretic peptide （NT proBNP） and blood lactic acid. Method： All patients with sepsis consecutively were admitted to the PICU in Hunan Children＇s hospital from Jan 2012 to Dec 2014. The levels of Lae,Myo,NT-proB- NP,cTnI were collected in this study. Result：The levels of Myo, NT-proBNP, cTnI and Lac were significantly higher in the septic shock group and severe sepsis group than those in non severe sepsis group（P〈0.05）. The level of Myo, NT-proBNP, cTnI were significantly higher in children with the blood lactic acid level ≥4 mmol/l, than in those with the blood lactic acid level〈4 mmol/L. A positive correlation between the level of Lac and Myo （r= 0. 364） ,BNP （r=0. 394） ,or cTnI （r=0. 357） were found in the study （P〈0. 001）. The level of blood lactic acid at 1 d and 3 d in children with myocardial injury were significantly higher than those of without myocardial injury （P〈0. 001）. Conclusion：The level of arterial blood lactate was considered as a biomarker of the severit of illness, prognosis and therapeutic effects in sepsis children. The positive correlation between the blood lactate level and the myocardial injury was found in this study. The clearance of Lac was affect by the myocardial injury in sepsis children.