2023 年第 6 期 第 18 卷

超声心动图联合B型脑钠肽在脓毒性心肌功能障碍患者预后评估中的价值

The value of echocardiography combined with brain natriuretic peptide in prognosis evaluation of patients with sepsis-induced myocardial dysfunction 

作者：吕欣炜巴音查汗·博然衣石晓卉肖东

英文作者：Lyu Xinwei Bayinchahan Boranyi Shi Xiaohui Xiao Dong

单位：新疆维吾尔自治区人民医院重症医学科，乌鲁木齐830001

英文单位：Department of Critical Care Medicine People′s Hospital of Xinjiang Uygur Autonomous Region Urumqi 830001 China

关键词：脓毒症；脓毒性心肌功能障碍；超声心动图；B型脑钠肽；预后

英文关键词：Sepsis;Sepsis-inducedmyocardialdysfunction;Echocardiography;Brainnatriureticpeptide;Prognosis

• 摘要：

• 目的  探讨超声心动图联合B型脑钠肽（BNP）在脓毒性心肌功能障碍（SIMD）患者预后评估中的价值。方法  选取2020年1月至 2022年1月就诊于新疆维吾尔自治区人民医院的脓毒症/脓毒性休克患者82例。根据后期剔除、完成随访、超声心动图检查结果及死亡情况分组。比较不同组间相关血清学指标及超声心动图指标，采用多因素Logistic回归方法分析影响患者心肌功能障碍发生的相关因素，采用受试者工作特征（ROC）曲线评估超声心动图联合BNP对SIMD患者预后的早期预测价值。结果  观察过程中2例分别因心肺复苏、急性冠状动脉综合征剔除，2例入住重症监护病房72 h内自动出院，最终入组并完成随访患者78例。根据患者是否存在左心室舒张功能障碍，分为心肌功能障碍组（32例）和心肌功能正常组（46例）；根据入院28 d死亡情况分为死亡组（28例）和存活组（50例）。心肌功能障碍组和死亡组血清BNP、白细胞介素6、心肌肌钙蛋白T、肌酸激酶、肌酸激酶同工酶、左心室舒张末期内径、左心室收缩末期内径、二尖瓣舒张早期血流峰值速度（E）/二尖瓣瓣环舒张早期血流峰值速度（e′）比值分别高于心肌功能正常组和存活组，E/二尖瓣舒张晚期血流峰值速度（A）比值分别低于心肌功能正常组和存活组，差异均有统计学意义（均P<0.05）。Logistic回归分析结果显示，BNP（比值比=1.947）、心肌肌钙蛋白T（比值比=1.615）、E/A比值（比值比=1.785）及E/e′比值（比值比=1.162）是脓毒症患者发生心肌功能障碍的独立影响因素（均P＜0.05）。超声心动图联合BNP对SIMD患者预后预测的ROC曲线下面积为0.906，敏感度为90.6%，特异度为90.8%。结论  BNP水平和超声心动图指标作为早期监测手段，在一定程度上能够反映SIMD的程度，并对SIMD患者预后判断具有重要意义。

• Objective    To explore the value of echocardiography combined with brain natriuretic peptide (BNP) in prognosis evaluation of patients with sepsis-induced myocardial dysfunction (SIMD). Methods  From January 2020 to January 2022, 82 patients with sepsis/septic shock admitted to People′s Hospital of Xinjiang Uygur Autonomous Region were selected. The patients were divided into groups according to the results of late elimination, completion of follow-up, echocardiographic results and death. The related serological indexes and echocardiographic indexes among different groups were compared. Multivariate Logistic regression method was used to analyze the related factors affecting the occurrence of myocardial dysfunction in patients. The receiver operating characteristic(ROC) curve was used to evaluate the early prognostic value of echocardiography combined with BNP in patients with SIMD. Results  During the observation, 2 cases were removed due to cardiopulmonary resuscitation and acute coronary syndrome, and 2 cases were discharged automatically within 72 h after admission to the intensive care unit. Finally, 78 patients were enrolled and followed up. The patients were divided into myocardial dysfunction group(32 cases) and normal myocardial function group(46 cases) according to whether the left ventricle showed diastolic dysfunction, and they were divided into death group(28 cases) and survival group(50 cases) according to the death on the 28th day of admission. The serum BNP, interleukin-6, cardiac troponin T, creatine kinase, creatine kinase isozyme, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and ratio of early mitral diastolic peak blood flow velocity(E)/early mitral annular diastolic peak blood flow velocity(e′) in the myocardial dysfunction group and the death group were higher than those in the normal myocardial function group and the survival group respectively, and ratios of E/late diastolic peak velocity of mitral valve(A) were lower than those in the normal myocardial function group and the survival group respectively (all P<0.05). Logistic regression analysis showed that BNP(odds ratio=1.947), cardiac troponin T(odds ratio=1.615), ratio of E/A(odds ratio=1.785) and ratio of E/e′ (odds ratio=1.162) were independent influencing factors of myocardial dysfunction in patients with sepsis(all P<0.05). The area under the ROC curve of echocardiography combined with BNP in predicting the prognosis of patients with SIMD was 0.906, the sensitivity was 90.6%, and the specificity was 90.8%. Conclusion  As early monitoring means, BNP level and echocardiographic indexes can reflect the degree of SIMD to a certain extent, and have important significance for the prognosis of patients with SIMD.