脓毒症性心脏功能障碍患者肌钙蛋白Ⅰ表达水平的变化及预后评估价值

Prognostic Value of a Change in Troponin-Ⅰ Levels in Patients with Sepsis-associated Myocardial Dysfunction

目的观察肌钙蛋白Ⅰ(cTnⅠ)在脓毒症性心脏功能障碍患者中的变化,探讨其与心脏舒缩功能的关系及评估脓毒症预后的价值。方法选取脓毒症患者65例,应用床旁心脏超声测定二尖瓣舒张早期峰流速与二尖瓣环舒张早期运动速度比值(E/e’)及左心室射血分数(LVEF),评估左心室舒张及收缩功能后将患者分为心功能障碍组和心功能正常组,检测并比较2组患者cTnⅠ水平,对其与心脏舒张及收缩功能指标进行相关性分析。根据住院28 d患者是否存活分为存活组和死亡组,比较2组cTnⅠ水平的差异,绘制受试者工作特征曲线,评估cTnⅠ预测脓毒症患者预后的价值。结果心功能障碍组cTnⅠ水平较心功能正常组明显增高(P<0.05);cTnⅠ水平与E/e’呈正相关(r=0.421,P=0.008),与LVEF相关性不显著(P>0.05)。与存活组比较,死亡组患者cTnⅠ明显升高(P<0.05)。cTnⅠ预测脓毒症患者死亡风险的曲线下面积为0.892,以0.82 ng/m L作为截点值,敏感度为88.0%,特异度为82.5%。结论伴有心脏功能障碍的脓毒症患者cTnⅠ水平明显升高,且与左心室舒张功能密切相关。cTnⅠ≥0.82 ng/m L可作为脓毒症患者死亡的可靠预测指标。

Objective To investigate the expression of cardiac troponin-I （cTn I ） levels in patients diagnosed with sepsis-associated myocardial dysfunction and explore the relationship between cTn I and cardiac systolic and diastolic function. Additionally,we evaluated the prognostic value of cTn I as a valuable biomarker. Methods We admitted 65 patients with sepsis. Using echocardiography, the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity （E/e＇） and the left ventricular ejection fraction （LVEF） were measured as an evaluation index of left ventricular diastolic and systolic function, respectively. Patients were divided into a cardiac dysfunction and a normal cardiac function group. The cTn I level was measured and compared between the two groups, and we determined the correlation between cTn I levels and cardiac diastolic and systolic function. Based on assessment of 28-day mortality, cases were divided into a survivor and a death group. A receiver operating characteristic curve was constructed to predict the prognostic value of cTn I. Results The eTn I level in the cardiac dysfunction group was significantly higher than that observed in the normal cardiac function group （P 〈 0.05） and showed a positive correlation with E/e＇ （r = 0.421 ,P = 0.008）. However, there was no correlation noted between the eTn I level and LVEF （P 〉 0.05）. Compared to the survivor group ,the level of eTn I was significantly higher in the death group （P 〈 0.05）. The prognostic value of cTn I area under the curve was 0.892, with a cut-off value of 0.82 ng/mL （sensitivity = 88.0% and specificity = 82.5%）. Conclusion The cTn I level is noted to be significantly elevated in patients with sepsis-associated cardiac dysfunction and shows a positive correlation with left ventricular diastolic function. A eTnI level ≥ 0.82 ng/mL can be used as a valuable predictor of mortality in patients with sepsis.