中国全科医学2018，Vol.21Issue(20)：2426-2431,6.DOI:10.12114/j.issn.1007-9572.2018.00.090
以心肌标志物为基础的脓毒症舒张性心功能障碍联合诊断模型的构建
Development of a Cardiac Marker-based Diagnostic Model for Sepsis-induced Left Ventricular Diastolic Dysfunction
摘要
Abstract
Objective To explore the risk factors for sepsis-induced left ventricular diastolic dysfunction (LVDD), and to develop and validate a cardiac marker-based diagnostic model for this disease.Methods We enrolled sepsis or septic shock from Emergency Department,Emergency Intensive Care Unit,Intensive Care Unit and Respiratory Intensive Care Unit,the First Affiliated Hospital of Xinjiang Medical University from August 2015 to August 2017,including 177 with normal cardiac function was normal cardiac function group,and 66 with sepsis-induced LVDD was sepsis-induced LVDD group. We collected their clinical data and laboratory findings.Co-predictor variable set pre1 (containing the associated variables for sepsis-induced LVDD included in the multivariate Logistic regression model) was used to construct a diagnostic model for sepsis-induced LVDD.Results Two groups showed significant differences in the age,systolic blood pressure,diastolic blood pressure,mean arterial pressure (MAP),heart rate,respiratory frequency,hemoglobin,INR,partial thromboplastin time (PTT),blood lactate,NT-proBNP,and heart-type fatty acid-binding protein (H-FABP),new arrhythmia (P<0.05). Multivariate Logistic regression analysis demonstrated that age,INR,PTT,NT-proBNP,H-FABP and new arrhythmia were associated with sepsis-induced LVDD (P<0.05).Multivariate Logistic regression equation was established:logit(P)=3.231+0.046age-0.344MPA+0.104NT-proBNP+0.065H-FABP+0.744new arrhythmia.Age,NT-proBNP,H-FABP and new arrhythmia were independent factors of sepsis-induced LVDD (P<0.05).For predicting sepsis-induced LVDD,the AUC of co-predictor variable set pre1 was larger than that of age,MAP,NT-proBNP,H-FABP,new arrhythmia (Z=1.798, P=0.040;Z=3.124,P=0.001;Z=1.894,P=0.032;Z=1.671,P=0.050;Z=1.901,P=0.026).Eighty patients with sepsis were randomly selected,the sensitivity,specificity,coincidence rate,positive likelihood ratio,and negative likelihood ratio of co-predictor variable set pre1 in predicting sepsis-induced LVDD was 78.12%,89.58%,85.00%,7.49,4.09,respectively. Conclusion Age,NT-proBNP,H-FABP and new arrhythmia are independent factors of sepsis-induced LVDD.The co-predictor variable set is superior to each of the variable alone in the diagnosis of sepsis-induced LVDD.The cardiac marker-based diagnostic model played a role in predicting sepsis-induced LVDD.关键词
脓毒症/生物学标记/心室功能障碍Key words
Sepsis/Biological markers/Ventricular dysfunction分类
医药卫生引用本文复制引用
杨建中,李转运,殷富康,李丹丹,汤宝鹏..以心肌标志物为基础的脓毒症舒张性心功能障碍联合诊断模型的构建[J].中国全科医学,2018,21(20):2426-2431,6.基金项目
国家自然科学基金资助项目(81570297) （81570297）
