摘要
目的 探讨血清巨噬细胞移动抑制因子（MIF）对严重脓毒症患者心肌抑制的预后价值.方法 采用前瞻性研究方法,对符合严重脓毒症诊断标准的42例患者进行研究,入住ICU当天知情同意后行PICCO监测,并给予相应治疗.入住当天根据血流动力学分为两组,心脏指数＜3 L/（min/m2）并且全心舒张末期容积指数＞800 ml/m2为心肌抑制组,其余为非心肌抑制组.根据28 d生存情况分为生存组和死亡组.入住第1,3,5天收集血流动力学指标及血清MIF、B型钠尿肽（BNP）、心肌肌钙蛋白I（cTnI）水平.结果 42例严重脓毒症患者中,未发生心肌抑制22例（非心肌抑制组）,发生心肌抑制20例（心肌抑制组）；28 d时,生存20例（生存组）,死亡22例（死亡组）.死亡组第1,3,5天血清MIF均高于生存组,差异有统计学意义（P＜0.01）；两组第1天BNP、cTnI比较差异无统计学意义（P＞0.05）,死亡组第3,5天BNP、cTnI均高于生存组,差异有统计学意义（P＜0.01）.心肌抑制组各时间点血清MIF水平均明显高于非心肌抑制组[生存：8.70（3.53,16.80） μg/L比1.20（0.80,1.77） μg/L、2.30（1.33,8.40） μg/L比0.60（0.60,0.99） μg/L、0.50（0.31,2.50） μg/L比0.16（0.15,0.20） μg/L,死亡：11.43（8.10,17.16）μg/L比2.30（1.96,3.69） μg/L、9.70（6.55,14.65）μg/L比1.90（1.88,5.27） μg/L、7.50（5.15,14.20） μg/L比2.40（0.80,8.46） μg/L],差异有统计学意义（P＜0.05）；且两组死亡患者血清MIF水平均高于生存患者,差异有统计学意义（P＜0.05）.第5天MIF具有最大预测价值,曲线下面积为0.952,当其截断点为0.65 μg/L时,其灵敏度为100％（22/22）,特异度为85％（17/20）.多因素Logistic回归分析结果显示,仅APACHEⅡ评分是28 d病死率的独立危险因素（P＜0.01）,而MIF不能独立预测28d病死率（P＞0.05）.结论 血清MIF水平升高提示严重脓毒症患者预后差,动态监测血清MIF变化有助于评估严重脓毒症患者心肌抑制的预后和严重程度,但MIF不是预测28 d病死率的独立危险因素.
Objective To evaluate the predictive value of serum macrophage migration inhibitory factor （MIF） for myocardial depression in severe sepsis patients.Methods Taken prospective study method,42 cases of severe sepsis patients were enrolled from December 2011 to June 2013.The patients were monitored by PICCO system after informing consent into ICU day,and given the corresponding treatment.According to the hemodynamic parameters were divided into two groups,myocardial depression group：cardiac index 〈 3 L/（min＆#183; m2） and global end diastolic volume index 〉 800 ml/m2,the remaining were in non myocardial depression group,and the patients were divided into survival group and death group according to 28-d mortality.Hemodynamic parameters and serum MIF,B-type natriuretic peptide （BNP）,cardiac troponin Ⅰ （cTnI） level at the 1st,3rd,Sth day after admission.Results Fortty-two severe sepsis patients,non myocardial depression in 22 cases （non myocardial depression group）,myocardial suppression in 20 cases （myocardial depression group）.At 28 d,20 patients of survival （survival group）,22 patients of death （death group）.The serum MIF in death group was higher than that in survival group at the 1st,3rd,5th day （P 〈 0.01） ; BNP and cTnI at the 1st day in two groups had no statistical significance （P 〉0.05）,BNP and cTnI at the 3rd,5th day in death group was higher than that in survival group（P 〈 0.01）.The serum MIF at each time point in myocardial depression group was higher than that in non myocardial depression group [survival：8.70（3.53,16.80） μ g/L vs.1.20（0.80,1.77） μ g/L,2.30（1.33,8.40） μ g/L vs.0.60 （0.60,0.99） μg/L,0.50 （0.31,2.50） μg/Lvs.0.16 （0.15,0.20） μg/L;death：11.43（8.10,17.16） μ g/L vs.2.30（1.96,3.69） μ g/L,9.70（6.55,14.65） μ g/L vs.1.90（1.88,5.27） μ g/L,7.50（5.15,14.20）μ g/L vs.2.40（0.80,8.46） μ g/L] （P 〈 0.05）.The serum MIF of death patients in two groups was higher than that of survival patients （P 〈 0.05）.MIF at the 5th day had biggest prediction value,AUC was 0.952,when the cut-off point of 0.65 μg/L,the sensitivity was 100% （22/22） and specificity was 85% （17/20）.Multivariable Logistic regression analysis results showed that only APACHE Ⅱ scores was the independent risk factor for 28-d mortality （P 〈 0.01）,while MIF couldn＆#39; t independent forecast 28-d mortality （P 〉 0.05）.Conclusions Elevation of serum MIF prompts severe sepsis patient with poor outcome,and dynamic changes of MIF is helpful to evaluate the prognosis and severity of severe sepsis patients with myocardial depression,but MIF is not an independent risk factor for predicting 28-d mortality.
出处
《中国医师进修杂志》
2014年第6期7-11,共5页
Chinese Journal of Postgraduates of Medicine
基金
天津医科大学第二医院科研基金（y1103）
关键词
脓毒症
心钠素
预后
心功能不全
Sepsis
Atrial natriuretic factor
Prognosis
Myocardial dysfunction
