Pro-BNP、cTnI在脓毒症心肌损伤患者中的应用价值

目的 脓毒症一旦出现心肌损伤病死率高，所以早期诊断至关重要，本文探讨Pro-BNP、cTnI在脓毒症心肌损伤患者中的应用价值。 方法 选取2016年2月—2017年8月杭州市第一人民医院危重病医学科收治的脓毒症心肌损伤患者40例，根据入院后心脏超声左室射血分数(LVEF)分为LVEF＞40%组(23例)和LVEF≤40%组(17例),根据预后分为存活组(24例)和死亡组(16例)，检测Pro-BNP、cTnI、乳酸水平；记录APACHEⅡ评分；心脏超声测量左室舒张期末内径(LVEDD)；PiCCO监测+dp/dt max。用ROC曲线下面积分析Pro-BNP、cTnI对脓毒症心肌损伤患者预后的预测价值，并分析Pro-BNP、cTnI与LVEF的相关性。 结果 LVEF＞40%组Pro-BNP、cTnI、乳酸、LVEDD、APACHEⅡ评分均低于LVEF≤40%组，LVEF＞40%组+dp/dt max高于LVEF≤40%组，差异均有统计学意义；存活组Pro-BNP、cTnI、乳酸、APACHEⅡ评分低于死亡组；存活组+dp/dt max高于死亡组，差异均有统计学意义。Pro-BNP对脓毒症心肌损伤患者预后的预测敏感性为0.82，特异性为0.80，ROC曲线下面积为0.88；cTnI的敏感性为0.93，特异性为0.88，ROC曲线下面积为0.96。Pro-BNP、cTnI与LVEF呈负相关(r=-0.360,P=0.023;r=-0.315,P=0.048)。 结论 脓毒症心肌损伤患者Pro-BNP、cTnI升高，Pro-BNP、cTnI水平升高提示预后不良。 

Clinical value of pro-BNP and cTnI in patients with sepsis related myocardial injury

Objective The mortality in sepsis patients with myocardial injury is high, and the early diagnosis is of great significance. The aim of this paper is to discuss the application of Pro-BNP and cTnI in patients with sepsis induced myocardial injury. Methods From February 2016 to August 2017, 40 patients with sepsis related myocardial injury in Department of Critical Care Medicine of Hangzhou First People's Hospital were recruited. According to left ventricular ejection fraction (LVEF) after admission, the patients were divided into LVEF>40% group (23 cases) and LVEF≤40% group (17 cases); Likewise, according to the prognosis, the patients were divided into survival group (24 cases) and death group (16 cases). The levels of Pro-BNP, cTnI and lactic acid were measured, APACHE Ⅱ score was recorded; LVEDD was measured by echocardiography, dp/dt max was monitored by PiCCO. The area under the ROC curve was used to analyze the prognostic value of Pro-BNP and cTnI in patients with sepsis related myocardial injury. The correlation among Pro-BNP, cTnI and LVEF were also analyzed. Results The Pro-BNP, cTnI, lactic acid, LVEDD, APACHEⅡ scores in the LVEF>40% group were all less than those in the LVEF≤40% group, and the dp/dt max was greater than the LVEF≤40% group, the difference was statistically significant; The Pro-BNP, cTnI, lactic acid, and APACHEII scores of the survival group were lower than those of the death group. The dp/dt max of the survival group was greater than that of the death group, and the differences were statistically significant. For prediction of prognosis in patients with sepsis myocardial injury, the sensitivity of Pro-BNP was 0.82, specificity was 0.80, an area under the ROC curve of 0.88; the sensitivity of cTnI was 0.93, specificity was 0.88, and the area under the ROC curve was 0.96. There was a negative correlation between Pro-BNP, cTnI and LVEF (r=-0.360, P=0.023; r=-0.315, P=0.048). Conclusion Both Pro-BNP and cTnI increases in the patients with sepsis related myocardial injury, the increase of pro-BNP and cTnI may correlate with poor prognosis.