脓毒症诱发Takotsubo心肌病危险因素分析

Analysis of risk factors for sepsis-induced Takotsubo cardiomyopathy

目的分析脓毒症诱发Takotsubo心肌病(Takotsubo cardiomyopathy,ITC)的危险因素。方法选取2015年3月至2018年3月期间宁海县第一医院急诊医学科治疗的241例脓毒症病例,收集患者入院后的临床资料:年龄、性别、体质量指数、心脏超声结果、炎症指标及心肌酶谱等实验室参数。根据筛选出的TTC患者,选取同时期的心脏功能正常的脓毒症患者,分为TTC组(n=31)和非TTC组(n=210)。在单变量分析中具有明显统计意义的变量引人多变量Logistic回归分析脓毒症诱发TTC的相关危险因素。结果最终TTC组31例,非TTC组210例。TTC组男性明显低于非TTC组(35.5%和56.7%,P=0.027),并且TTC组肌钙蛋白T(cTnT)、氨基末端B型利尿钠前体(NT-proBNP)、肌酸肌酶同工酶(CK-MB)等心肌酶谱指标均明显升高(P<0.05)。在治疗方案上,TTC组使用正性肌力药物的比例明显高于非TTC组(45.2%和26.7%,P=0.034)。超声心动图检查结果显示,TTC组左室射血分数(LVEF)明显低于非TTC组(39.5±10.4和59.3±5.7,P<0.001),而左心室收缩末期内径(LVIDs:3.42±0.74和2.59±0.53,P<0.001)和左心室舒张末期内径(LVIDd:4.62±0.52和4.31±0.51,P=0.002)均较非TTC组增大;TTC组与非TIC组比较舒张功能参数如E波(P=0.160)、A波(P=0.093),E波减速时间(P=0.098)和E与e'(s)之比(P=0.649)差异均无统计学意义。多因素分析结果显示,cTnT水平升高(OR1.965,95%CI1.122~3.785,P≤0.001)和正性肌力药物(OR1.445,95%CI1.217~4.263,P<0.001)是脓毒症诱发TTC的独立危险因素。结论cTnT水平升高、正性肌力药物是脓毒症诱发TIC的危险因素,对于这类高风险患者需进行早期监测和预防。

Objective To analyze the risk factors for sepsis-induced Takotsubo cardiomyopathy(TTC).Methods A total of 241 cases with sepsis admitted to our hospital from March 2015 to March 2018 were analyzed.Clinical parameters at admission were collected:age,sex,body mass index,echocardiography results,and laboratory parameters such as inflammation index and myocardial enzyme spectrum.According to the selected TTC patients,sepsis patients with normal cardiac function were selected and divided into TTC group and non-TTC group.Variables with significant statistical significance in the univariate analysis were introduced with multivariate logistic regression analysis of sepsis-induced risk factors for TTC.Results There were 31 cases in TTC group and 210 cases in the non-TTC group.The males in the TTC group were significantly lower than those in the non-TTC group(35.5%vs.56.7%,P=0.027),and the myocardial enzyme spectrum of cTnT,NT-proBNP,and CK-MB were significantly higher in the TTC group(P<0.05).In treatment regimens,the proportion of introotropic drugs used in the TTC group was significantly higher than that in the non-TTC group(45.2%vs.26.7%,P=0.034).Echocardiographic results showed a significant reductionin left ventricular ejection fraction in the TIC group(39.5±10.4 vs.59.3±5.7,P<0.001).The left ventricular end systolic diameter(LVIDs)(3.42±0.74 vs.2.59±0.53,P<0.001)and left ventricular end-diastolic diameter(LVIDd)(4.62±0.52 vs.4.31±0.51,P=0.002)increased compared with the non-TTC group.There was no statistical difference in diastolic function parameters such as E wave(P=0.160),A wave(P=0.093),E wave deceleration time(P=0.098)and E and e'(s)ratio(P=0.649).Multivariate analysis showed that troponin T(OR=1.965,95%CI 1.122-3.785,P<0.001)and inotrope(OR=1.445,95%CI1.217-4.263,P<0.001)were independent risk factors for sepsis-induced TTC.Concluson Increased troponin levels and positive inotropic agents are risk factors for TTC after sepsis.Early detection and prevention of these high-risk patients is warranted.