左心室应变和扭转对冠心病患者心脏功能水平的关系研究

目的 研究左心室应变和扭转对冠心病患者心脏功能水平的关系。方法 选取我院于2016年10月到2017年10月收治的冠心病患者70例,按照纽约临床心功能分级积分(NYHA-P)分为纽约临床心功能分级正常组38例,心功能分级异常组32例,以及再选择体检正常的志愿者30位作为对照组,比较受检者的NYHA-P、左室射血分数(LVEF)、总体心肌整体径向应变(GRS)、纵向应变(GLS)、左室心肌收缩期心肌扭转角度(TA)。结果 冠心病患者组与对照组比较,LVEF、GLS、GRS、TA降低。心功能分级正常组与异常组相比,LVEF、GLS、GRS、TA降低。心功能正常组GLS、GRS、TA与LVEF无相关性,与NYHA-P相关。心功能异常组GLS、GRS、TA与LVEF及NYHA-P都相关。心功能分级异常组以GLS-14.75%截断点判定患者NYHAP积分高于4.5分的灵敏度为87.45%,特异度为72%,Youden指数最高为0.653。结论 左心室应变和扭转与冠心病患者心脏功能水平相关,可以有效评价冠心病患者的临床心脏功能水平。

Relationship between adrenal function and prognosis in patients with severe sepsis

Background It is known that the hypothalamic-pituitary-adrenal （HPA） axis is highlighted by stimulation, such as sepsis, trauma, etc, when corticortropin increases and plasma cortisol levels enhance. Relative adrenal insufficiency is not uncommon in critically ill patients and may occur in severe sepsis patients with high plasma cortisol levels. It has been demonstrated that a short corticotropin test has a good prognostic value and is helpful in identifying patients with septic shock at high risk for death, but it has not been established for all severe sepsis patients, especially in China. The aim of this study is to explore the relationship between adrenal function and prognosis in patients with severe sepsis. Methods This prospective study was conducted between July and December 2004 in 6 teaching hospitals. Two hundred and forty patients with severe sepsis were enrolled in this study. A short corticotropin stimulation test was performed in all patients by intravenous injection of 250 pg of corticotropin. Blood samples were taken immediately before the test （TO）, 30 （T30） and 60 （T60） minutes afterward, and the plasma cortisol concentration was measured by radio-immunoassay. At the onset of severe sepsis, the following parameters were recorded： age, sex, Acute Physiology and Chronic Health Evaluation （APACHE） II, heart rate, mean arterial pressure （MAP）, arterial partial pressure of oxygen （PaO2）/fraction of inspired oxygen （FiO2）, peripheral blood of hemoglobin, platelets and leukocyte concentration and the number of organ failure. Patients were designated into two groups （survival and non-survival groups） according to the 28-day mortality. Relative adrenal insufficiency was defined as the difference between TO and the highest value of T30 or T60 （△Tmax） ≤9 μg/dl. Results （1） Two hundred and forty patients with severe sepsis were included in this study, with 134 patients in the survival group and 106 in the non-survival group. The 28-day mortality was 44.2%. （2） Between the survival group and non-survival group age, APACHE II, peripheral blood of platelets, the number of organ failures, TO and ATmax showed significant differences. TO was （23±10） μg/dl and （36＋18） μg/dl in the survival group and nonsurvival group respectively. △Tmax was （18±9） and （10±8） μg/dl in the survival group and non-survival group respectively. The areas under the ROC curve for TO and ATmax were both 0.72, and the area under the ROC curve for APACHE II was 0.70. By multivariate analysis age, TO, the number of organ failures and relative adrenal insufficiency （△Tmax ≤9 μg/dl） were independent predictors of death. （3） The incidence of relative adrenal insufficiency was 38.3% in total, 19.4% in the survival group and 62.3% in the non-survival group （P〈0.001）. The 28-day mortality was 71.7% among the relative adrenal insufficiency patients but 27.0% among normal adrenal function patients. Conclusions The prevalence of relative adrenal insufficiency is high in severe sepsis. Relative adrenal insufficiency has a good prognostic value for severe sepsis.