中国全科医学2017，Vol.20Issue(9)：1042-1048,7.DOI:10.3969/j.issn.1007-9572.2017.09.005
心型脂肪酸结合蛋白和N-末端脑钠肽前体在脓毒症心肌损伤中的临床研究
Roles for Heart - type Fatty Acid - binding Protein and N - terminal Probrain Natriuretic Peptide in Myocardium Injury in Sepsis
摘要
Abstract
Objective To investigate the expressions and clinical values of heart - type fatty acid - binding protein (H-FABP)and N - terminal probrain natriuretic peptide (NT-proBNP)in myocardium injury in sepsis. Methods The subjects enrolled in this study were 98 sepsis patients (50 diagnosed with severe sepsis,and 48 with septic shock on admission)who were treated in Emergency Intensive Care Unit (EICU)and Intensive Care Unit of Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2014 to March 2016 and 50 controls underwent physical examination in this hospital during the same period. The 98 sepsis patients were divided into myocardium injury group (62 with value of LVEF≤50%)and non -myocardium injury group (36 with value of LVEF > 50%)based on the value of left ventricular ejection fraction (LVEF) obtained from the ultrasound cardiogram (UCG)performed on admission. The measurement of H-FABP,NT-proBNP,troponin I (cTnI),creatine kinase isoenzyme (CKMB)and creatine kinase (CK)in venous blood samples of 3 ml was performed in sepsis patients at 1 h,6 h and 24 h after admission,and in the controls during the physical examination,respectively. And changes in scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)of all groups were recorded. Results At 1 h after admission,the levels of H-FABP,NT-proBNP and APACHEⅡscore in septic shock group were significantly higher than those in severe sepsis group (P < 0. 05). At 6 h after admission,the levels of H-FABP,NT-proBNP,cTnI and APACHEⅡscore were higher in septic shock group than in severe sepsis group (P < 0. 05). At 24 h after admission,septic shock group had higher levels of NT-proBNP,cTnI and APACHEⅡscore than severe sepsis group (P < 0. 05). In both severe sepsis and sepsis shock groups,the levels of H-FABP,NT-proBNP,cTnI,CKMB,CK and APACHE Ⅱ scores measured at 1 h after admission differed significantly from those measured at 6 h after admission (P < 0. 05),and those measured at 6 h after admission also differed remarkably from those measured at 24 h after admission (P < 0. 05). At 1 h after admission,there were significant differences in the levels of H-FABP,NT-proBNP and APACHEⅡscore between myocardium injury group and non - myocardium injury group (P < 0. 05). At 6 h after admission,significant differences in the levels of H-FABP,NT-proBNP,cTnI,CKMB, CK and APACHEⅡscore were observed between myocardium injury group and non - myocardium injury group (P < 0. 05). At 24 h after admission,the levels of NT-proBNP,cTnI,CKMB,CK and APACHE Ⅱ score in myocardium injury group differed significantly from those in non - myocardium injury group (P < 0. 05). In myocardium injury group,there were significant differences in the levels of H-FABP,NT-proBNP,cTnI,CKMB,CK and APACHE Ⅱ score between 6 h and 1 h after admission (P < 0. 05),and between at 24 h and 6 h after admission (P < 0. 05). In non - myocardium injury group, APACHE Ⅱ score measured at 6 h after admission was lower than that measured at 1 h after admission (P < 0. 05),and that measured at 24 h after admission was lower than that measured at 6 h after admission (P < 0. 05). In sepsis patients,positive correlations were found between level of H-FABP and APACHE Ⅱ score measured both at 1 h and 6 h after admission (r 1 h= 0. 353,P 1 h < 0. 001;r 6 h = 0. 256,P 6 h = 0. 011);and positive relationship existed between level of NT-proBNP and APACHE Ⅱ score measured both at 1 h and 6 h after admission (r 1 h = 0. 254,P 1 h = 0. 011;r 6 h = 0. 263,P 6 h = 0. 009). Conclusion Values of H-FABPand NT-proBNP are of important reference significance in the early diagnosis and reasonable prescription for myocardium injury in sepsis.关键词
脓毒症/休克,脓毒性/心肌损伤/脂肪酸结合蛋白质类/N-末端脑钠肽前体Key words
Sepsis/Shock/septic/Myocardium injury/Fatty acid - binding proteins/N - terminal probrain natriuretic peptide分类
医药卫生引用本文复制引用
齐洪娜,张建军,何佳起,王维展,李雅琴..心型脂肪酸结合蛋白和N-末端脑钠肽前体在脓毒症心肌损伤中的临床研究[J].中国全科医学,2017,20(9):1042-1048,7.基金项目
衡水市科学技术研究与发展计划项目(15019) （15019）
