Analysis on myocardial injury and risk factors in elderly patients with sepsis-related ventricular diastolic dysfunction
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摘要: 目的 分析老年脓毒症相关心脏舒张功能不全患者的心肌损伤情况及危险因素。方法 收集老年脓毒症患者92例，行床旁心脏超声检查，根据心脏舒张功能是否不全分为脓毒症相关心脏舒张功能不全组(观察组)和心脏舒张功能正常组(对照组)，于入院第1天及第3天行心肌损伤标志物检查并比较2组患者的临床特征。采用logistic回归模型分析脓毒症患者发生心脏舒张功能不全的独立危险因素。结果 脓毒症患者发生心脏舒张功能不全的比例为41.3%(38/92)，即观察组38例。与对照组(54例)相比，观察组患者年龄更大，既往有高血压病史者所占比例更高(均P< 0.05)；在心肌损伤方面，2组于第3天肌钙蛋白I(cTnI)及肌酸激酶同工酶CK-MB均高于第1天(均P< 0.05)，且观察组在第3天cTnI水平高于对照组(P=0.012)。logistic回归模型分析显示患者年龄(OR=2.184，95%CI：1.129~3.320)、cTnI(OR=1.964，95%CI：1.573~2.495)是预测脓毒症患者发生心脏舒张功能不全的独立危险因素(均P< 0.05)。结论 老年脓毒症相关心脏舒张功能不全患者发生心肌损伤的情况更为严重，而年龄、cTnI是发病的高危因素。Abstract: Objective To study the myocardial injury and risk factors in elderly patients with sepsis-related ventricular diastolic dysfunction.Methods Ninety-two elderly patients with sepsis underwent echocardiogram were divided into diastolic dysfunction group(observation group) and normal diastolic function group(control group). Meanwhile, levels of the markers of myocardial injury and clinical characteristics were monitored in 1st day and 3rd day. Logistic regression was performed to analyze the independent risk factors of diastolic dysfunction in patients with sepsis.Results In patients with sepsis, diastolic dysfunction accounted for 41.3%(38/92). Observation group had older age and more patients with history of hypertension than control group(allP< 0.05). In terms of myocardial injury, compared with 1st day, cTnI and CK-MB elevated in 3rd day in both groups(allP< 0.05). In addition, compared with control group, cTnI elevated in 3rd day in observation group(P=0.012). Logistic regression analysis showed that age(OR=2.184, 95%CI: 1.129-3.320), cTnI(OR=1.964, 95%CI: 1.573-2.495) were the independent risk factors associated with diastolic dysfunction in patients with sepsis(allP< 0.05).Conclusion Myocardial injury is more serious in elderly patients' sepsis-related ventricular diastolic dysfunction. Age and cTnI are high risk factors.
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Key words:
- sepsis /
- cardiac diastolic function /
- myocardial injury /
- troponin I /
- elderly
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表 1 2组一般资料比较
X±S，例(%) 临床资料 观察组(n=38) 对照组(n=54) χ2/t P 年龄/岁 73.6±15.4 65.2±14.7 4.961 0.003 性别/例 0.421 0.622 男 26 31 女 12 23 基础疾病 高血压 21(55.3) 19(35.2) 3.523 0.019 慢性阻塞性肺疾病 9(23.7) 11(20.4) 0.575 0.594 2型糖尿病 6(15.8) 8(14.8) 0.628 0.434 原发感染部位 肺脏 18(47.4) 27(50.0) -0.389 0.629 腹腔 13(34.2) 17(31.5) 0.492 0.501 软组织 4(10.5) 5(9.3) 0.365 0.668 血流 3(7.9) 5(9.3) -0.298 0.721 APACHE Ⅱ评分/分 25.1±10.3 21.8±8.5 2.734 0.038 住院时间/d 12.2±5.3 7.8±4.3 3.836 0.014 28 d死亡 12(31.6) 16(29.6) 0.514 0.480 
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表 2 2组心脏超声指标比较
X±S 指标 观察组(n=38) 对照组(n=54) χ2/t P E/(m·s-1) 0.86±0.32 0.88±0.29 -0.338 0.627 e’/(cm·s-1) 5.7±2.3 11.3±3.6 -5.913 ＜0.001 E/ e’ 15.2±5.3 7.8±2.4 6.472 ＜0.001 A/(m·s-1) 0.93±0.36 0.87±0.33 2.457 0.039 E/A 0.92±0.15 1.01±0.13 -2.238 0.046 LAVImax/(mL·m-2) 48.6±14.2 41.5±12.9 2.837 0.035 TRmax/(m·s-1) 2.8±1.2 2.2±0.7 2.192 0.047 LVEF/% 57±19 56±15 0.424 0.618
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表 3 2组心肌损伤标志物比较
X±S 组别 cTnI/(ng·mL-1) CK-MB/(U·L-1) 第1天 第3天 t P 第1天 第3天 t P 观察组(n=38) 0.13±0.05 1.28±0.941) 5.836 < 0.001 18.0±10.3 27.6±11.9 2.687 0.031 对照组(n=54) 0.14±0.06 0.59±0.25 4.568 0.002 16.6±8.7 29.9±11.6 2.931 0.028 与对照组第3天cTnI水平比较，1)P < 0.05。
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表 4 脓毒症相关心脏舒张功能不全的logistic回归分析
自变量 β SE Wald χ2 OR P 95%CI 下限 上限 年龄 3.289 0.685 10.409 2.184 0.005 1.129 3.320 高血压 2.351 0.632 5.412 1.343 0.247 0.847 2.011 cTnI 0.934 0.427 6.928 1.964 0.032 1.573 2.495 CK-MB 0.346 0.594 9.227 1.351 0.072 1.019 1.686 APACHE Ⅱ评分 2.754 0.682 6.184 1.837 0.353 1.158 2.614 住院时间 1.958 0.576 4.641 1.559 0.194 1.203 2.176
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