摘要目的 探讨超声心动图指标联合心肌肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)、N端B型脑钠肽前体(NT-proBNP)对脓毒症患者预后的早期预测价值.方法 选取2014年7月至2018年10月本院重症医学科收治的脓毒症患者189例.根据住院期间心脏舒张、收缩功能是否障碍分为心功能障碍组(104例)、心功能正常组(85例);根据入院28 d内存活与否分为死亡组(58例)、存活组(131例).观察各组入院确诊后24h内外周血cTNT、cTNI、NT-proBNP及超声心动图指标(EDD、E/A)水平;评估各指标预测患者预后的价值.结果 心功能障碍组患者cTNT、cTNI、NT-proBNP、EDD分别为(0.34±0.17)μg/、(0.25±0.14) μg/L、(6.01 ±0.79) μg/L、(53.91±6.45)mm,明显高于心功能正常组的(0.09±0.03)μg/L、(0.05±0.01)μg/L、(5.02±0.51)μg/L、(47.69±6.08)mm(P＜ 0.05),心功能障碍组患者E/A(0.96±0.13)明显低于心功能正常组(1.41±0.45) (P＜ 0.05).死亡组患者cTNT、cTNI、NT-proBNP、EDD均高于存活组(P＜0.05),E/A低于存活组(P＜0.05).ROC曲线显示预后预测价值:五项指标联合＞cTNI＞ NT-proBNP＞cTNT＞E/A＞EDD,cTNI、NT-proBNP、cTNT的曲线下面积(AUC)均＞0.9,预测价值较高.结论 超声心动图指标联合cTNT、cTNI、NT-proBNP有助于早期判断脓毒症患者的预后,有一定的临床意义.

abstractsObjective To investigate the early value of echocardiography combined with cardiac troponin T (cTnT),cardiac troponin I(cTNI),and N-terminal pro-brain natriuretic peptide (NT-proBNP) in evaluating prognosis in sepsis patients.Methods A total of 189 patients with sepsis admitted to the Department of Critical Care Medicine from July 2014 to October 2018 were enrolled.According to the diastolic and systolic function during hospitalization,the patients were divided into cardiac dysfunction group (104 cases) and normal heart function group (85 cases).According to the survival within 28 days after admission,they were divided into death group (58 cases) and survival group (131 cases).Peripheral blood cTNT,cTNI,NT-proBNP,and echocardiographic indexes (EDD,E/A) levels were observed within 24 hours after admission in each group.The value of each index in evaluating prognosis was evaluated.Results The levels of cTNT,cTNI,NT-proBNP,and EDD in patients with cardiac dysfunction were (0.34±0.17) μg/L,(0.25±0.14) μg/L,(6.01±0.79) μg/L,(53.91±6.45) mm respectively,which were significantly higher than those in patients with normal cardiac function [(0.09±0.03) μg/L,(0.05±0.01) μg/L,(5.02±0.51) μg/L,(47.69±6.08) mm] (P＜0.05);E/A in patients with cardiac dysfunction was (0.96±0.13),which was significantly lower than that in patients with normal cardiac function [(1.41±0.45)] (P＜0.05).The levels of cTNT,cTNI,NT-proBNP,and EDD in the death group were higher than those in the survival group (P＜0.05),and E/A was lower than that in the survival group (P＜0.05).The ROC curve showed the prognostic predictive value of the five indicators:combined five indicators ＞cTNI ＞NT-proBNP ＞cTNT ＞E/A ＞EDD,and the area under the curve (AUC) of cTNI,NT-proBNP,and cTNT were all ＞0.9,with higher predictive value.Conclusion Combined detection of cTNT,cTNI,NT-proBNP,and echocardiography is helpful to early judgment of prognosis of sepsis patients,with certain clinical significance.