2023 年第 5 期 第 18 卷

脓毒症继发心肌损伤患者短期发生主要不良心脑血管事件的危险因素分析

Analysis of risk factors of short-term major adverse cardio-cerebral vascular events in patients with sepsis induced myocardial injury

作者：张锋曾亚平王成钢祖晓麟曾玉杰

英文作者：Zhang Feng Zeng Yaping Wang Chenggang Zu Xiaolin Zeng Yujie

单位：首都医科大学附属北京安贞医院心内科冠心病中心，北京100029

英文单位：Coronary Heart Disease Center of Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：脓毒症；心肌损伤；主要不良心脑血管事件；危险因素

英文关键词：Sepsis;Myocardialinjury;Majoradversecardio-cerebralvascularevents;Riskfactors

• 摘要：

• 目的 探究脓毒症继发心肌损伤（SIMI）患者短期发生主要不良心脑血管事件（MACCE）的危险因素。方法 本研究为单中心回顾性病例对照研究。连续性纳入2015年1月至2019年12月首都医科大学附属北京安贞医院收治的脓毒症或脓毒症休克患者127例。根据是否合并SIMI分为SIMI组（34例）和对照组（93例）。出院后平均随访30 d，主要观察指标为MACCE，包括全因死亡、因心力衰竭再入院、急性心肌梗死和脑卒中。次要观察指标为住院时间，包括重症监护病房住院时间和总住院时间。采用单因素和多因素Cox风险比例回归方法分析SIMI患者发生MACCE的危险因素。结果  SIMI组年龄、心率及降钙素原、血乳酸、心肌肌钙蛋白T、N末端B型脑钠肽前体（NT-proBNP）水平大于/高于对照组，二尖瓣舒张早期血流速度峰值/舒张晚期血流速度峰值比值、左心室射血分数（LVEF）低于对照组，差异均有统计学意义（均P＜0.05）。随访期间SIMI组MACCE总发生率显著高于对照组（P=0.042），且总住院时间明显长于对照组（P=0.048）。多因素Cox风险比例回归分析发现，年龄（风险比=2.348，95%置信区间：1.304～4.229）、NT-proBNP（风险比=4.226，95%置信区间：2.087～8.564）、血乳酸水平（风险比=3.641，95%置信区间：2.369～5.618）和LVEF（风险比=3.605，95%置信区间：1.327～9.790）均是SIMI患者发生MACCE的危险因素（均P＜0.05）。结论   SIMI患者短期发生MACCE的风险高，住院时间长，年龄、NT-proBNP、血乳酸水平和LVEF是发生MACCE的危险因素。

• Objective  To explore the risk factors of short-term major adverse cardio-cerebral vascular events (MACCE) in patients with sepsis induced myocardial injury (SIMI). Methods This was a single center retrospective case control study. From January 2015 to December 2019, 127 patients with sepsis or septic shock admitted to Beijing Anzhen Hospital, Capital Medical University were included consecutively. They were divided into SIMI group (34 cases) and control group (93 cases) according to whether combined with SIMI. The average follow-up time after discharge was 30 d, and the main outcome measure was MACCE, including all-cause death, readmission due to heart failure, acute myocardial infarction and stroke. Secondary outcome measure was length of stay, including length of stay in the intensive care unit and total length of stay. The risk factors for MACCE in patients with SIMI were analyzed by univariate and multivariate Cox risk proportional regression Methods . ResultsThe levels of age, heart rate, procalcitonin, blood lactate, cardiac troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP) in the SIMI group were greater/higher than those in the control group, and the ratio of peak blood flow velocity of early diastole of mitral valve to peak blood flow velocity of late diastole and left ventricular ejection fraction (LVEF) in the SIMI group were lower than those in the control group (all P<0.05). During the follow-up period, the total incidence of MACCE in the SIMI group was higher than that in the control group (P=0.042), and the total hospital stay was longer than that in the control group (P=0.048). Multivariate Cox proportional regression analysis showed that age［hazard ratio(HR)=2.348, 95% confidence interval (CI): 1.304-4.229］, NT-proBNP (HR=4.226, 95%CI: 2.087-8.564), blood lactate level (HR=3.641, 95%CI: 2.369-5.618) and LVEF (HR=3.605, 95%CI: 1.327-9.790) were all risk factors for MACCE in patients with SIMI (all P<0.05). Conclusions Patients with SIMI have a high risk of MACCE in the short term, with a long hospital stay. Age, NT-proBNP, blood lactate level and LVEF are risk factors for MACCE.