感染性休克患者左心室收缩功能与心脏生物标志物的关系

Relationship between left ventricular systolic function and cardiac biomarkers in septic shock:a cohort study

目的评估感染性休克患者心肌肌钙蛋白I(c Tn I)、N末端B型利钠肽原(NT-pro BNP)等心脏生物标志物与左心室收缩功能间的关系及对预后判断的价值。方法本研究为前瞻性研究,纳入2010年1月至2012年1月出现感染性休克后24 h内收入北京协和医院的69例患者。根据患者生存情况分为存活组和死亡组,在入院第1、2、4、7和10天收集临床资料、心脏生物标志物和超声心动图指标,并计算90 d全因死亡率。结果 69例感染性休克患者90 d死亡率为40.6%(28例)。与死亡组相比,存活组基线的左室各室壁心肌峰值收缩速度(Sm)和Sm平均值(Sm-mean)均较低(均为P≤0.01),而生物标志物基线水平相似(均为P>0.05)。平均随诊(4.8±2.6)d中,存活组NT-pro BNP(2 648 pg/ml)和c Tn I(0.06 mg/L)水平下降(均为P<0.05),左室各室壁Sm及Smmean改善(均为P<0.05);而死亡组NT-pro BNP水平(6 136mg/L)升高(P=0.03),c Tn I和Sm无变化(均为P>0.05)。在存活组中,生物标志物与左心室收缩功能相关(均为P<0.01)。结论感染性休克生存组患者的左心室收缩功能较死亡组低,且短期左室收缩功能的改善以及生物标志物恢复更为明显。生物标志物水平与左心室收缩功能仅在90 d存活感染性休克人群中相关。

Objective To assess the relationship between cardiac biomarkers such as cardiac troponin I（cTnI ） and N-terminal pro-brain natriuretic peptide（NT-proBNP） and the left ventricular（LV） systolic function and the prognostic value in patients with septic shock. Methods Between January 2010 and January 2012, sixty-nine patients who were admitted to Peking Union Medical College Hospital within 24 hours after the onset of septic shock were prospectively evaluated. Survival group and death group were divided according to patient＇s survival. The clinical variables,cardiac biomarkers including cardiac troponin I （cTnI）and N-terminal-pro-brain natriuretic peptide（NT-proBNP）,and echocardiography data were obtained on admission （ Day 1） and at Days 2, 4 , 7 ,and 10. The 90 d all-cause mortality was calculated. Results The 90 d mortality was 40. 6% （28/69） . Compared to the death group,the survivors had a lower baseline peak myocardial systolic velocity（Sm）and mean Sm（Sm-mean）（all P ≤ 0. 01）with same baseline level of biomarkers（all P〉 0. 0 5 ） . During the mean follow-up period of （4. 8 ± 2. 6 ） days, NT-proBNP （2 648 pg/ml） and cTnl （0. 06 mg/L） decreased significantly （al l P 〈0. 05 ） , Sm and Sm-mean improved significantly （all P 〈 0. 0 5 ） in the survivors曰 whereas significantly increased NT-proBNP （6 136 mg/L） （P = 0. 03） ,and unchanged cTnl and Sm（all P 〉0. 05） ,were observed in the death group. The biomarkers correlated with Sm and LVEF only in the survivor group （ all P 〈0. 01）. Conclusions The survivors of septic shock had lower LV systolic function than the non-survivors. However, the survivor group showed LV systolic function improved in short-term and biomarkers decreased significantly during short period. The level of biomarkers correlates with LV systolic function exists only in the survivors of septic shock at 90 days.