内源性洋地黄因子对脓毒症心肌损伤和预后的预测价值

Predictive value of endogenous digitalis-like factor on myocardial injury and mortality in sepsis

目的研究内源性洋地黄因子(EDLF)动态变化对脓毒症心肌损伤和预后的预测价值。方法选取2017年7月至2019年1月首都医科大学附属北京友谊医院急诊科收治的脓毒症患者160例,根据有无心肌损伤分为心肌损伤组75例,非心肌损伤组85例。检测受试者入组第1、3、7天时的血浆EDLF(EDLF 1st、EDLF 3rd、EDLF 7^(th))水平。记录90 d患者生存情况。Logistics回归分析脓毒症患者心肌损伤和死亡的独立危险因素。Cox比例风险回归模型分析EDLF水平对脓毒症患者预后的预测价值。结果与非心肌损伤组相比,心肌损伤组脓毒症患者心肌酶水平更高,左室短轴缩短指数及室间隔振幅更小,异常室壁运动比例更高,差异均有统计学意义(均P<0.05)。心肌损伤组入组第7天的EDLF水平低于非心肌损伤组(P=0.019)。Logistic回归显示,EDLF 7^(th)是脓毒症患者心肌损伤和死亡的独立预测因子(OR=0.964,95%CI:0.934~0.994,P=0.021;OR=0.931,95%CI:0.871~0.995,P=0.036)。Cox比例风险回归模型显示,EDLF 7^(th)水平<26.7 pmol/L是脓毒症患者90 d死亡的独立预测因子(HR=4.601,95%CI:1.030~20.563,P=0.046)。结论EDLF 7^(th)是脓毒症所致心肌损伤和不良预后的保护因子。心肌损伤后一周外源性补充强心药物可能是提高脓毒症患者生存率的潜在治疗方法。

Objective To evaluate the value of endogenous digitalis-like factor(EDLF)dynamic changes in predicting myocardial injury and prognosis in patients with sepsis.Methods A total of 160 sepsis patients admitted to the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to January 2019 were selected and divided into the myocardial injury(MI)group(n=75)and the non-myocardial injury(NMI)group(n=85)according to whether there was myocardial injury.The plasma EDLF concentration was tested on the 1^(st),3^(rd) and 7^(th) day after admission.The predictive factors of MI and 90-days outcome were evaluated by logistics regression analysis.Cox proportional hazards regression model was used to estimate the prognostic value of EDLF concentration on the 90 days after admission for sepsis.Results Septic patients with MI had increased levels of myocardial enzymes,decreased left ventricular fractional shortening index(FS)and interventricular septum(IVS)amplitude and abnormal wall motion,when compared to NMI patients(all P<0.05).EDLF concentration on the 7^(th) day in the MI group was significantly lower than in the NMI group(P=0.019).Logistic regression showed that EDLF 7^(th) was an independent protective factor for MI and 90-day mortality in sepsis respectively(OR=0.964,95%CI:0.934-0.994,P=0.021;OR=0.931,95%CI:0.871-0.995,P=0.036).Cox proportional hazards regression analysis suggested that EDLF 7^(th) concentration<26.7 pmol/L was an independent predictor of 90-day mortality in patients with sepsis(HR=4.601,95%CI:1.030-20.563,P=0.046).Conclusions EDLF 7^(th) may serve as a protective factor for sepsis-induced MI and adverse outcome.The exogenous supplement of cardiotonic drugs at one week after MI may be a potential treatment to improve the survival rate of septic patients.