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论著·临床研究 | 更新时间:2026-05-12
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左心室整体纵向应变联合血清肌钙蛋白Ⅰ、N末端B型利钠肽在脓毒症合并心肌病诊断及预后中的预测价值
redictive value of left ventricular global longitudinal strain combined with serum cardiac troponin Ⅰ and N⁃terminal pro⁃B⁃type natriuretic peptide in the diagnosis and prognosis of sepsis and concomitant cardiomyopathy

广西医学 页码:493-498

作者机构:方笑媚,本科,副主任医师,研究方向为重症医学。

基金信息:东莞市社会发展科技项目(20231800936882)

DOI:10.11675/j.issn.0253⁃4304.2026.04.09

  • 中文简介
  • 英文简介
  • 参考文献

目的 探讨左心室整体纵向应变(GLS)联合血清肌钙蛋白Ⅰ(cTnⅠ) 、N末端B型利钠肽(NT⁃proBNP)在脓毒症合并心肌病诊断和预后中的预测价值。方法 选取80例脓毒症合并心肌病患者作为研究组,80例无心肌病的脓毒症患者作为对照组。两组患者入院后通过超声心动图二维斑点追踪技术测量左心室GLS,并取其静脉血检测血清cTnⅠ、  NT⁃proBNP水平。比较研究组左心室GLS绝对值>20%、左心室GLS绝对值≤20%患者的血清cTnⅠ、  NT⁃proBNP水平,并采用Pearson相关法分析左心室GLS与血清cTnⅠ、  NT⁃proBNP水平之间的相关性。两组均持续治疗观察28 d,统计患者28 d死亡率。比较研究组与对照组、研究组中死亡与存活患者的左心室GLS和血清cTnⅠ、 NT⁃proBNP水平。绘制受试者工作特征(ROC)曲线分析左心室GLS和血清cTnⅠ、  NT⁃proBNP水平在脓毒症合并心肌病诊断及预后评估中的预测价值。结果 研究组患者的左心室GLS绝对值低于对照组,血清cTnⅠ、  NT⁃proBNP水平和28 d死亡率高于对照组(P<0.05)。研究组左心室GLS绝对值>20%患者的血清cTnⅠ、  NT⁃proBNP水平低于左心室GLS绝对值≤20%患者(P<0.05)。Pearson相关分析结果显示,研究组患者左心室GLS绝对值与血清cTnⅠ、  NT⁃proBNP水平呈负相关(P<0.05)。研究组死亡患者的左心室GLS绝对值低于存活患者,血清cTnⅠ、  NT⁃proBNP水平高于存活患者(P<0.05)。ROC曲线分析结果显示,左心室GLS绝对值、血清cTnⅠ    和NT⁃proBNP水平单独预测脓毒症合并心肌病发生和预后的曲线下面积均>0.5,且三者联合检测的曲线下面积最大。结论 脓毒症合并心肌病患者的左心室GLS绝对值降低而血清cTnⅠ、  NT⁃proBNP水平升高,三者联合检测可有效诊断脓毒症合并心肌病及预测其不良预后风险。

Objective To explore the predictive value of left ventricular global longitudinal strain (GLS) combined with serum cardiac troponinⅠ (cTnⅠ) and N⁃terminal pro⁃B⁃type natriuretic peptide (NT⁃proBNP) in the diagnosis and prognosis of sepsis and concomitant cardiomyopathy. Methods A total of 80 patients with sepsis and concomitant cardiomyopathy were selected as the study group, and 80 patients with sepsis without cardiomyopathy were selected as the control group. After admission, the left ventricular GLS was measured by two⁃dimensional speckle tracking echocardiography in both groups, and patients' venous blood were collected for detecting the levels of serum cTnⅠ and NT⁃proBNP. The levels of serum cTnⅠ and NT⁃proBNP were compared between patients with absolute value of left ventricular GLS >20% and those with absolute value of left ventricular GLS ≤20% in the study group. The correlation between left ventricular GLS and serum cTnⅠ and NT⁃proBNP levels was analyzed by Pearson correlation method. Both groups were continuously treated and observed for 28 days, and the 28⁃day mortality rate was calculated. The left ventricular GLS and serum cTnI and NT⁃proBNP levels were compared between the study group and the control group, and between the deceased and the survived patients in the study group. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of left ventricular GLS and serum cTnⅠ and NT⁃proBNP levels in the diagnosis and prognosis of sepsis and concomitant cardiomyopathy. Results The absolute value of left ventricular GLS in the study group was lower than that in the control group, and the levels of serum cTnⅠ and NT⁃proBNP and the 28⁃day mortality rate were higher than those in the control group (P<0.05). The levels of serum cTnⅠ and NT⁃proBNP in patients with absolute value of left ventricular GLS>20% in the study group were lower than those in patients with absolute value of left ventricular GLS≤20% in the study group (P<0.05). The Pearson correlation analysis results revealed that the left ventricular GLS absolute value negatively correlated with the levels of serum cTnⅠ and NT⁃proBNP in the study group (P<0.05). The absolute value of left ventricular GLS in deceased patients in the study group was lower than that in survived patients in the study group, and the levels of serum cTnⅠ and NT⁃proBNP were higher than those in survived patients in the study group (P<0.05). The results of ROC curve analysis indicated that the area under the curve of left ventricular GLS absolute value, serum cTnⅠ and NT⁃proBNP levels for alone predicting the occurrence and prognosis of sepsis and concomitant cardiomyopathy was greater than 0.5, and the area under the curve of the combination detection of the three was the largest. Conclusion The absolute value of left ventricular GLS is decreased while the levels of serum cTnⅠ and NT⁃proBNP are elevated in patients with sepsis and concomitant cardiomyopathy. The combined detection of the three can effectively diagnose sepsis and concomitant cardiomyopathy and predict its adverse prognosis risk.

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