高敏肌钙蛋白和N末端B型利钠肽检测对脓毒症心肌损伤的价值

Diagnostic value of highly sensitive cardiac troponin T and N-terminal pro-brain natriuretic peptide in myocardial injury of sepsis

目的:探讨血清高敏肌钙蛋白(hs-cTnT)和N末端B型利钠肽(NT-proBNP)水平与脓毒症患者心肌损伤早期诊断及与脓毒症预后的关系。方法:采用前瞻性研究方法,选择2016-08—2017-08期间辽宁省人民医院急诊科重症监护病房(EICU)的患者118例,将患者分一般感染组(32例)、脓毒症组(51例)和脓毒性休克组(35例);再将脓毒症组和脓毒性休克组按静息状态下左心室射血分数分(EF值)分组:EF≥50%为心功能正常组,EF值<50%为心功能异常组;以同期健康人20例作为对照组。记录当日急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分最高值。记录入EICU 6h内血清hs-cTnT和NT-proBNP水平最高值,记录第28天转归。将各组间变量进行分析比较,绘制受试者工作特征(ROC)曲线,判断hs-cTnT、NT-proBNP和APACHEⅡ评分对脓毒症预后的预测价值。结果:hs-cTnT在对照组是(10.04±7.41)pg/ml,一般感染组是(43.87±11.29)pg/ml,脓毒症组是(81.80±5.29)pg/ml,脓毒性休克组是(94.57±8.31)pg/ml,hs-cTnT水平随着病情严重程度增加而逐渐升高,组间差异均有统计学意(F=615.281,P=0.000);NT-proBNP在对照组是(222.30±91.28)pg/ml,一般感染组是(729.07±456.37)pg/ml,脓毒症组是(4 346.51±2 327.02)pg/ml,脓毒性休克组是(7 169.97±3781.91)pg/ml,随着病情严重程度增加而逐渐升高,但是在对照组和一般感染组间差异无统计学意义(P=1.000),其余各组间差异有统计学意义(F=54.726,P=0.000);hs-cTnT在脓毒症心功能正常组是(79.50±5.79)pg/ml,脓毒症心功能异常组是(84.20±3.42)pg/ml,脓毒性休克心功能正常组是(89.57±3.23)pg/ml,脓毒性休克心功能异常组是97.90±9.03pg/ml,在心功能正常组间、心功能异常组间及心功能正常组与心功能异常组间差异均有统计学意义(F=40.276,P=0.000),在病情严重程度相同时,心功能异常组hs-cTnT水平高于心功能正常组;NT-proBNP在脓毒症心功能正常组是(2 750.12±1 527.84)pg/ml,脓毒症心功能异常组是(6006.76±1 799.08)pg/ml,脓毒性休克心功能正常组是(4 811.78±1 696.05)pg/ml,脓毒性休克心功能异常组是(8 742.10±3 994.64)pg/ml,NT-proBNP在心功能正常组间、心功能异常组间均差异有统计学意义(F=23.905,P=0.000),NT-proBNP在脓毒症心功能异常组和脓毒性休克心功能正常组间差异无统计学意义(P=0.256)。在受试者工作特征曲线分析中NT-proBNP和APACHEⅡ的曲线下面积相近分别为0.895、0.880,hs-cTnT曲线下面积为0.837,低于前二者。结论:hs-cTnT、NT-proBNP可作为脓毒症心肌损伤的早期诊断指标,在一定程度上反应脓毒症心肌损伤的严重程度;NT-proBNP可以作为预测脓毒症心肌损伤患者预后的指标。

Objective:To investigate the relationship between serum highly sensitive cardiac troponin T(hs-cTnT)and N-terminal pro-brain natriuretic peptide(NT-proBNP)and early diagnosis of myocardial injury in patients with sepsis and prognosis of sepsis.Method:A prospective study was conducted.From August 2016 to August2017,118 patients in emergency intensive care unit(EICU)of the people’s hospital of Liaoning province were selected.Patients were divided into general infection group(n=32),sepsis group(n=51)and septic shock group(n=35),then sepsis group and the septic shock group were divided into abnormal cardiac function group and normal cardiac function group according to the resting state of left ventricular ejection fraction(EF)(EF≥50%is considered as normal cardiac function group,EF<50% is considered as abnormal cardiac function group).A control group of 20 healthy people was selected.The acute physiology and chronic health evaluation system Ⅱ(APACHEⅡ)score were recorded.The maximum values of hs-cTnT and NT-proBNP in serum were recorded within 6hours of EICU.Record the 28-day prognosis.Comparison between groups of variables,a receiver operator characteristic curve(ROC curve)was plotted to compare the power of hs-cTnT,NT-proBNP and APACHE Ⅱscore in predicting the outcome.Result:Hs-cTnT gradually increased with the severity of the disease,control group(10.04±7.41)pg/ml,general infection group(43.87±11.29)pg/ml,sepsis group(81.80±5.29)pg/ml,the septic shock group(94.57±8.31)pg/ml,the difference between the groups was statistically significant(F=615.281,P=0.000).NTproBNP gradually increased with the severity of the disease,control group(222.30±91.28)pg/ml,general infection group(729.07±456.37)pg/ml,sepsis group(4 346.51±2 327.02)pg/ml,the septic shock group(7 169.97±3 781.91)pg/ml,but there was no statistically significant difference between control group and general infected group(P=1.000),and the difference between the other groups was statistically significant(F=54.726,P =0.000).Hs-ctnt was(79.50±5.79)pg/ml in normal cardiac function group with sepsis,(84.20±3.42)pg/ml in abnormal cardiac function group with sepsis,(89.57±3.23)pg/ml in normal cardiac function group with septic shock,(97.90±9.03)pg/ml in abnormal cardiac function group with septic shock.Hs-ctnt showed statistical significance between the normal cardiac function groups,between the abnormal cardiac function groups and between the normal cardiac function group and the abnormal cardiac function group(F=40.276,P=0.000).In the same degree of severity,hs-cTnT in the abnormal cardiac function group were higher than those in the normal cardiac function group.NT-proBNP was(2 750.12±1 527.84)pg/ml in normal cardiac function group with sepsis,(6006.76±1 799.08)pg/ml in abnormal cardiac function group with sepsis,(4 811.78±1 696.05)pg/ml in normal cardiac function group with septic shock,(8 742.10±3 994.64)pg/ml in abnormal cardiac function group with septic shock.NT-proBNP showed statistical significance between the normal cardiac function groups and between the abnormal cardiac function groups(F=23.905,P =0.000).NT-proBNP showed no statistically significant difference between the abnormal cardiac function of sepsis group and the normal cardiac function of sepsis shock group(P=0.256).To analysis ROC curve in the NT-proBNP and APACHEⅡarea under the curve of the similar were 0.895 and 0.880,hs-cTnT area under the curve was lower than that before both of 0.837.Conclusion:Hs-cTnT and NT-proBNP can be used as early diagnostic indicators of sepsis myocardial injury.To some extent,they reflect the severity of sepsis myocardial injury.NT-proBNP can be used to predict the prognosis of patients with sepsis myocardial injury.