超声心动图监测老年急性重症感染患者细胞因子风暴下心脏的变化

Changes of the heart during cytokine storm in elderly with acute severe infection by echocardiography

目的超声心动图对老年急性重症感染并发细胞因子风暴患者心脏检测及分析。方法回顾性分析解放军总医院第二医学中心老年男性急性重症感染患者31例,检测白细胞计数(WBC)、中性粒细胞计数(N)、淋巴细胞计数(LWBC)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTn)T、cTnI、N末端B型钠尿肽前体(NT-proBNP)水平。采用超声心动图检测。采用彩色多普勒超声测量三尖瓣反流速度(TRV),三尖瓣反流压差(TRPG)及肺动脉收缩压(SPAP)等。结果老年急性重症感染发病时CRP、WBC、N、LWBC、LDH、CK-MB、cTnT、cTnI、NT-proBNP明显高于发病前和病情缓解后(P<0.01)。31例(100%)患者发病时均出现超声心动图异常;左心室均出现节段性或弥漫性室壁运动减弱,且TRV,TRPG,SPAP高于发病前[(4.26±1.81)m/s vs(2.91±0.78)m/s,(69.50±6.45)mm Hg(1 mm Hg=0.133 kPa)vs(34.81±2.81)mm Hg,(72.20±9.87)mm Hg vs(38.83±4.34)mm Hg,P<0.01]。经治疗病情缓解后,患者超声心动图检测恢复或接近急性发病前。结论老年急性重症感染患者细胞因子风暴下易发生心脏损伤,超声心动图可直观、准确监测心脏的变化。

Objective To survey and analyze the changes of the heart during cytokine storm in elderly patients with acute severe infection by echocardiography.Methods A total of 31 elderly male patients with acute severe infection admitted in our medical center were enrolled.Their WBC,eutrophil(N),LWBC,CRP,LDH,CK-MB,cTnT,cTnI,and NT-proBNP were collected.ECG was performed.Color Doppler ultrasound exam was used for TRV,TRPG and SPAP.Results Their WBC,N and LWBC,and levels of CRP,LDH,CK-MB,cTnT,cTnI and NT-proBNP were significantly higher during the period of acute severe infection than before onset and after remission(P<0.01).At the onset,all of the 31 patients(100%)had abnormal electrocardiogram,segmental or generalized left ventricular hypokinesia,and obviously elevated TRV,TRPG and SPAP than before onset[(4.26±1.81)m/s vs(2.91±0.78)m/s,(69.50±6.45)mm Hg(1 mm Hg=0.133 kPa)vs(34.81±2.81)mm Hg,(72.20±9.87)mm Hg vs(38.83±4.34)mm Hg,P<0.01].After remission,their electrocardiogram got back or approached the conditions before the onset.Conclusion During cytokine storm,elderly SIRS patients are prone to heart injury.Echocardiography can directly and accurately display the changes in the heart.