TNF-α、Pro-BNP在脓毒症心功能障碍中的作用

目的 脓毒症一旦出现心功能障碍死亡率高，所以早期诊断有重大的临床意义，本文探讨肿瘤坏死因子-α(TNF-α)、B型脑钠肽前体(Pro-BNP)在脓毒症心功能障碍中的作用。 方法 选择2015年8月—2016年10月收住杭州市第一人民医院的脓毒症心功能障碍患者50例入院后24 h检查心脏超声，根据左室射血分数(LVEF)分为LVEF＞40%组和LVEF≤40%组,根据预后分为存活组和死亡组，检测TNF-α浓度、Pro-BNP浓度、心肌肌钙蛋白I (TNI)水平；记录急性生理与慢性健康(APACHEⅡ)评分，测量左室收缩末期内径(LVSD)，分析TNF-α、Pro-BNP与APACHEⅡ评分及LVEF的相关性，用ROC曲线分析TNF-α、Pro-BNP对于心功能障碍诊断的特异性和敏感性。 结果 LVEF＞40%组TNF-α、Pro-BNP、APACHEⅡ评分均小于LVEF≤40%组，差异有统计学意义；存活组TNF-α、TNI小于死亡组，2组Pro-BNP、LVSD比较P<0.01；存活组的LVEF (40.03±1.50)高于死亡组(38.76±2.86)，但差异无统计学意义。TNF-α、Pro-BNP与APACHEⅡ评分存在相关性(r=0.88，P<0.05；r=0.70，P<0.05)，TNF-α、Pro-BNP与LVEF呈负相关(r=-0.76,P<0.05；r=-0.79,P<0.05)，TNF-α的ROC曲线下面积0.772，Pro-BNP的ROC曲线下面积0.771。 结论 脓毒症心功能障碍患者TNF-α、Pro-BNP升高，TNF-α、Pro-BNP升高提示预后不良。 

The role of TNF-α and Pro-BNP in sepsis induced myocardial dysfunction

Objective Once sepsis appears cardiac dysfunction,mortality is high,so early diagnosis has significant clinical significance,this study explored the role of tumor necrosis factor-α(TNF-α) and pro-B-type brain natriuretic peptide(Pro-BNP) in sepsis induced myocardial dysfunction. Methods Fifty patients with Sepsis induced myocardial dysfunction were involved.After 24 h admission according to cardiac ultrasound examination for left ventricular ejection fraction(LVEF),the patients were divided into LVEF ≤ 40% group and LVEF>40% group.According to the prognosis was divided into survival group and death group.TNF-α,B-type pro-brain natriuretic peptide(Pro-BNP) and TNI were measured in the selected patients.APACHE Ⅱ score was recorded.Left ventricular end-diastolic diameter(LVSD) was measured by echocardiography.The levels of TNF-α,Pro-BNP and APACHE Ⅱ scores and the correlation between TNF-α,Pro-BNP and LVEF were analyzed.The ROC curve was used to evaluate the specificity and sensitivity of TNF-α and Pro-BNP in the diagnosis of cardiac dysfunction. Results The levels of TNF-α,Pro-BNP and APACHEⅡ in LVEF>40% group were lower than those in LVEF ≤ 40% group.The difference was statistically significant.TNF-α,TNI in survival group was lower than that in death group.Pro-BNP,LVSD in the two groups was P<0.01;LVEF (40.03±1.50) was significantly higher than that in the death group(38.76±2.86),but no statistically significant difference.There was correlation between TNF-α,Pro-BNP and APACHEⅡ score(r=0.88,P<0.05;r=0.70,P<0.05).TNF-α and Pro-BNP were negatively correlated with LVEF(r=-0.76,P<0.05;r=-0.79,P<0.05).The area under the ROC curve of TNF-α was 0.772 and the area under the ROC curve of Pro-BNP was 0.771. Conclusion TNF-α and Pro-BNP were significantly increased in patients with Sepsis induced myocardial dysfunction.The increase of TNF-α and Pro-BNP correlated with poor prognosis.