糖原磷酸化酶同工酶脑型在脓毒症心肌损伤早期的诊断价值

The diagnostic value of glycogen phosphorylase isoenzyme BB in myocardium injury in sepsis

目的:探讨糖原磷酸化酶同工酶脑型(GPBB)在脓毒症心肌损伤早期的诊断价值。方法:收集2018-02-2019-02期间在潍坊医学院附属医院重症医学科诊断为脓毒症及脓毒性休克的患者54例(其中脓毒症组32例,脓毒性休克组22例),并收集同期本院体检人员20例为对照组。在诊断为脓毒症后1、6 h监测cTnI、NT-proBNP、CK、CK-MB、GPBB水平的变化,对照组于体检时检测上述指标。根据脓毒症与脓毒性休克患者入院24 h内超声心动图结果有无左室射血分数<50%,分为心肌损伤组与非心肌损伤组。结果:诊断脓毒症1 h,脓毒症组NT-proBNP、GPBB水平高于对照组(P<0.05),脓毒性休克组NT-proBNP、GPBB水平高于脓毒症组(P<0.05);诊断脓毒症6 h,脓毒性休克组cTnI、NT-proBNP、CK、CK-MB和GPBB水平高于脓毒症组(P<0.05);脓毒症组与脓毒性休克组cTnI、NT-proBNP、CK、CK-MB、GPBB水平在诊断脓毒症6 h与诊断脓毒症1 h比较,差异均有统计学意义(P<0.05)。诊断脓毒症1 h心肌损伤组NT-proBNP、GPBB水平较非心肌损伤组升高,差异均有统计学意义(P<0.05);诊断脓毒症6 h心肌损伤组cTnI、NT-proBNP、CK、CK-MB、GPBB水平较非心肌损伤组升高,差异均有统计学意义(P<0.05)。在诊断脓毒症1 h,GPBB诊断心肌损伤的ROC曲线下面积为0.842±0.065。在诊断脓毒症6 h,GPBB和cTnI诊断心肌损伤的ROC曲线下面积分别为0.820±0.069、0.838±0.074。结论:GPBB对脓毒症心肌损伤的早期诊断价值优于传统心肌标志物。

Objective: To investigate the diagnostic value of glycogen phosphorylase isoenzyme BB(GPBB) in the early stage of myocardium injury in sepsis. Method: A total of 54 patients with sepsis or septic shock(32 patients in the sepsis group and 22 patients in the septic shock group) were enrolled in the Department of Critical Care Medicine, the Affiliated Hospital of Weifang Medical College from February 2018 to February 2019. In the same period, 20 physical examination personnel in our hospital composed the control group, The levels of cTnI, NT-proBNP, CK, CK-MB, and GPBB were measured at 1 h and 6 h after the diagnosis of sepsis, and they was tested for changes in the above indicators at the time of physical examination in the control group. Sepsis group and the septic shock group were divided into myocardial injury group and non-myocardial injury group according to the results of echocardiography within 24 hours after admission. The left ventricular ejection fraction(LVEF) ≥50% is considered as non-myocardial injury group, LVEF<50% is considered as myocardial injury group. Result: At 1 h after admission, the levels of NT-proBNP and GPBB in the sepsis group were higher than those in the control group(P<0.05), and the levels of NT-proBNP and GPBB in the septic shock group were higher than those in the sepsis group(P<0.05). At 6 h after admission, the levels of cTnI, NT-proBNP, CK, CKMB and GPBB in septic shock group were higher than those in sepsis group(P<0.05). In both sepsis and sepsis shock groups, the levels of cTnI, NT-proBNP, CK, CK-MB and GPBB measured at 1 h after admission differed significantly from those measured at 6 h after admission(P<0.05). The levels of NT-proBNP and GPBB in the myocardial injury group were significantly higher than those in the non-myocardial injury group at 1 h after admission(P<0.05). The levels of cTnI, NT-proBNP, CK, CK-MB and GPBB in the myocardial injury group were higher than those in the non-myocardial injury group at 6 h after admission. The differences were statistically significant(P<0.05). At 1 h after admission, the area under the ROC curve for GPBB diagnosis of myocardial injury was 0.842±0.065. At 6 h after admission, the area under the ROC curve for GPBB and cTnI diagnosis of myocardial injury was 0.820±0.069 and 0.838±0.074, respectively. Conclusion: The early diagnostic value of GPBB for sepsis myocardial injury is superior to traditional myocardial markers.