广西医学

目的探讨血清白细胞介素6（IL⁃6）、降钙素原（PCT）及心肌肌钙蛋白Ⅰ（cTnⅠ）在脓毒症性心肌抑制患者中的表达情况及其对患者预后的预测价值。方法选取140例脓毒症性心肌抑制患者作为研究对象，根据入院28 d预后情况分为死亡组（n=67）和生存组（n=73）。比较两组患者的临床资料和实验室资料，采用多因素Logistic回归模型分析影响脓毒症性心肌抑制患者预后的因素，并通过受试者工作特征（ROC）曲线评估血清IL⁃6、PCT和cTnⅠ 水平单独及三者联合预测脓毒症性心肌抑制患者预后的价值。结果死亡组患者的糖尿病病史比例、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康评估Ⅱ（APACHEⅡ）评分及血清IL⁃6、B型利钠肽（BNP）、cTnⅠ 、PCT水平高于生存组（P<0.05）。多因素Logistic回归分析结果显示，有糖尿病病史，SOFA评分和APACHEⅡ评分高，以及血清IL⁃6、BNP、cTnⅠ 、PCT水平升高是脓毒症性心肌抑制患者预后不良的危险因素（P<0.05）。ROC曲线分析结果显示，血清IL⁃6、PCT、cTnⅠ 水平单独及三者联合预测脓毒症性心肌抑制患者发生不良预后的灵敏度分别为67.2%、97.0%、58.2%、83.6%，特异度分别为69.9%、34.2%、61.6%、89.0%，曲线下面积（AUC）分别为0.712、0.623、0.601、0.918，三者联合预测的AUC大于单独预测的AUC（P<0.05）。结论血清IL⁃6、PCT和cTnⅠ 水平异常升高是脓毒症性心肌抑制患者预后不良的危险因素，且三者联合预测的效能较高，可作为预测脓毒症性心肌抑制患者预后的有效生物标志物。

Objective To investigate the expressions of serum interleukin 6 (IL⁃6), procalcitonin (PCT), and cardiac troponin Ⅰ(cTnⅠ) in patients with sepsis⁃induced myocardial dysfunction and their predictive value for the prognosis of these patients. Methods A total of 140 patients with sepsis⁃induced myocardial dysfunction were selected as the research subjects, and they were divided into death group (n=67) or survival group (n=73) according to prognosis 28 days after admission. The clinical and laboratory data were compared between the two groups. Multivariate Logistic regression model was used to analyze factors affecting the prognosis of patients with sepsis⁃induced myocardial dysfunction. The value of serum IL⁃6, PCT, and cTnⅠ levels for alone and jointly predicting the prognosis of these patients was evaluated using receiver operating characteristic (ROC) curve. Results The proportion of patients with a history of diabetes mellitus, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ ) score, and serum levels of IL⁃6, B⁃type natriuretic peptide (BNP), cTnⅠ , and PCT in the death group were higher than those in the survival group (P<0.05). Multivariate Logistic regression analysis revealed that a history of diabetes mellitus, high SOFA and APACHEⅡ scores, and elevated serum levels of IL⁃6, BNP, cTnⅠ , and PCT were risk factors for poor prognosis in patients with sepsis⁃induced myocardial dysfunction (P<0.05). ROC curve analysis results indicated that the sensitivities of serum IL⁃6, PCT, cTnⅠ levels for alone and jointly predicting poor prognosis in patients with sepsis⁃induced myocardial dysfunction were 67.2%, 97.0%, 58.2%, and 83.6%, respectively, the specificities were 69.9%, 34.2%, 61.6%, and 89.0%, respectively, and areas under the curve (AUC) were 0.712, 0.623, 0.601, and 0.918, respectively. The AUC of the combined prediction of the three was greater than that of the individual predictions (P<0.05). Conclusion Abnormally elevated serum levels of IL⁃6, PCT, and cTnⅠ are risk factors for poor prognosis in patients with sepsis⁃induced myocardial dysfunction. The combination of the three has high predictive performance and can serve as effective biomarkers for predicting the prognosis of patients with sepsis⁃induced myocardial dysfunction.