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目的:探讨脓毒性休克致左心室舒张功能障碍患者肌钙蛋白I(c Tn I)的变化及临床价值。方法:回顾性分析重症医学科(ICU)收治的脓毒性休克致左心室舒张功能障碍患者38例(Sa组),脓毒性休克心功能正常患者20例(Sn组),未诊断脓毒性休克但发生左心室舒张功能障碍患者20例作为对照组(Ca组),于入ICU 72 h内应用超声心动图通过测定二尖瓣舒张早期峰流速与二尖瓣环舒张早期运动速度比值(E/e′)评估心脏舒张功能,同时检测c Tn I。比较各组c Tn I水平差异及其与E/e′相关性。绘制受试者工作者特征曲线(ROC),评估c Tn I预测脓毒性休克患者致左心室舒张功能障碍发生的价值。结果:Sa组、Sn组的c Tn I水平均较Ca组明显增高(P<0.05);Sa组c Tn I水平、E/e′明显高于Sn组(P<0.05)。c Tn I与E/e′呈正相关(r=0.367,P=0.004)。ROC显示c Tn I为0.49 ng/m L时预测脓毒性休克致左心室舒张功能障碍发生的曲线下面积为0.834,敏感度为77.6%,特异度为80.7%。结论:脓毒性休克患者c Tn I水平明显升高,c Tn I升高与脓毒性休克致左心室舒张功能障碍密切相关,c Tn I≥0.49 ng/m L可有效预测脓毒性休克致左心舒张功能障碍的发生。
Objective: To investigate the changes and clinical value of troponin I (cTn I) in patients with left ventricular diastolic dysfunction induced by septic shock. Methods: Thirty-eight patients with left ventricular diastolic dysfunction induced by septic shock (group Sa) and 20 patients with normal septic shock (group Sn) were retrospectively analyzed in the intensive care unit (ICU). However, septic shock was not diagnosed Twenty patients with left ventricular diastolic dysfunction were selected as control group (Ca group). Echocardiography was performed within 72 hours after ICU. The ratio of early diastolic mitral flow velocity to mitral annular early diastolic velocity (E / e ’) Assessment of diastolic function, simultaneous detection of cTnI. The differences of cTn I levels between groups and their correlation with E / e ’were compared. The receiver operating characteristic curve (ROC) was plotted to assess the value of cTnI in predicting the occurrence of left ventricular diastolic dysfunction in patients with septic shock. Results: The levels of cTn I in Sa group and Sn group were significantly higher than those in Ca group (P <0.05). The levels of cTn I and E / e ’in Sa group were significantly higher than those in Sn group (P <0.05). cTn I was positively correlated with E / e ’(r = 0.367, P = 0.004). ROC showed that the area under the curve of predicted left ventricular diastolic dysfunction in septic shock was 0.834 with a sensitivity of 77.6% and a specificity of 80.7% at a cTn I of 0.49 ng / m L. CONCLUSIONS: The level of cTnI is significantly increased in septic shock patients. Elevated cTnI is closely related to left ventricular diastolic dysfunction induced by septic shock. CTn I≥0.49 ng / m L can effectively predict the left heart caused by septic shock Diastolic dysfunction occurs.