中性粒细胞明胶酶相关脂质运载蛋白对老年脓毒症心功能障碍的诊断和预后评估价值

Value of neutrophil gelatinase-associated lipid carrier protein in the diagnosis and prognosis of myocardial injury in the elderly patients with sepsis

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对老年脓毒症心功能障碍的诊断及预后的评估价值。方法选择2016年6月至2019年6月南京医科大学附属老年医院ICU收治的老年脓毒症病人132例,所有病人于入院时抽取静脉血检测NGAL、BNP、肌钙蛋白(cTn)I、肌酸激酶同工酶MB(CK-MB)及肌红蛋白(Mb)。根据入院时LVEF将病人分为心功能障碍组(LVEF≤50%)54例和非心功能障碍组(LVEF>50%)78例,比较2组一般资料、NGAL、BNP、cTnI、CK-MB、Mb水平的差异;在脓毒症心功能障碍亚组中分析病人NGAL水平与LVEF、BNP、cTnI、CK-MB、Mb的相关性;根据28 d预后分为生存组及死亡组,比较不同预后病人间NGAL、LVEF、BNP、cTnI、CK-MB及Mb水平的差异。结果脓毒症心功能障碍组病人年龄、脓毒症相关序贯器官衰竭(SOFA)评分、BNP、cTnI、Mb及NGAL水平显著高于非心功能障碍组(P<0.05或P<0.01);脓毒症心功能障碍病人入院时的NGAL水平与LVEF呈负相关(r=-0.725,P<0.001),与BNP(r=0.432,P=0.001)、Mb(r=0.348,P=0.010)呈正相关。脓毒症心功能障碍死亡组的NGAL水平明显高于生存组(391.17±143.11)比(197.29±65.41)ng/mL,P<0.01。结论老年脓毒症病人发生心功能障碍时,NGAL水平明显升高,与传统诊断指标具有较高一致性,且在死亡病人中NGAL水平更高,提示NGAL对老年脓毒症心功能障碍的诊断及预后判断具有重要意义。

Objective To explore the value of neutrophil gelatinase-associated lipid carrier protein(NGAL)in the diagnosis and prognosisi of myocardial injury in the elderly patients with sepsis.Methods A total of 132 elderly patients with sepsis were selected from the intensive care unit of Geriatric Hospital of Nanjing Medical University from June 2016 to June 2019.At admission,the levels of NGAL,B-type natriuretic peptide(BNP),cardiac troponin(cTn)I,creatine kinase isoenzyme MB(CK-MB)and myoglobin(Mb)were detected.According to left ventricular ejection fraction(LVEF)measured by echocardiography at admission,the patients were divided into myocardial injury group(LVEF<50%,n=54)and non-myocardial injury group(LVEF>50%,n=78).The differences in general data,NGAL and other markers of myocardial injury between the two groups were analyzed.The correlation of NGAL with LVEF,BNP,cTnI,CK-MB and Mb in sepsis myocardial injury subgroup was analyzed.According to the 28-day prognosis,the patients in the myocardial injury group were divided into survival group and death group,and the levels of NGAL,LVEF,BNP,cTnI,CK-MB and Mb in the two groups were compared.Results The levels of NGAL,BNP,cTnI,Mb and the score of sequential organ failure assessment(SOFA)in myocardial injury group were significantly higher than those in non-myocardial injury group(P<0.05).The level of NGAL at admission in myocardial injury group was negatively correlated with LVEF(r=-0.725,P<0.001),and positively correlated with BNP(r=0.432,P=0.001),Mb(r=0.348,P=0.010).The level of NGAL in the death group was significantly higher than that in the survival group(P<0.01).Conclusions The level of NGAL in the elderly patients with sepsis-induced myocardial injury increases significantly,which is consistent with the traditional diagnostic indicators,and is higher in the dead patients.This suggests that NGAL is of great significance in the diagnosis and prognosis of sepsis myocardial injury in the elderly patients.