脓毒症诱发Takotsubo心肌病危险因素分析

doi:10.3969/j.issn.1002-1949.2019.05.006

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摘要目的分析脓毒症诱发Takotsubo心肌病(Takotsubo cardiomyopathy，TTC）的危险因素。方法选取2015年3月至2018年3月期间宁海县第一医院急诊医学科治疗的241例脓毒症病例，收集患者入院后的临床资料：年龄、性别、体质量指数、心脏超声结果、炎症指标及心肌酶谱等实验室参数。根据筛选出的TTC患者，选取同时期的心脏功能正常的脓毒症患者，分为TTC组（n=31）和非TTC组（n=210）。在单变量分析中具有明显统计意义的变量引入多变量Logistic回归分析脓毒症诱发TTC的相关危险因素。结果最终TTC组31例，非TTC组210例。TTC组男性明显低于非TTC组（35.5%和56.7%，P=0.027），并且TTC组肌钙蛋白T（cTnT）、氨基末端B型利尿钠前体（NT-proBNP）、肌酸肌酶同工酶（CK-MB）等心肌酶谱指标均明显升高（P＜0.05）。在治疗方案上，TTC组使用正性肌力药物的比例明显高于非TTC组（45.2%和26.7%，P=0.034）。超声心动图检查结果显示,TTC组左室射血分数（LVEF）明显低于非TTC组（39.5±10.4和59.3±5.7，P<0.001），而左心室收缩末期内径（LVIDs:3.42±0.74和2.59±0.53，P<0.001）和左心室舒张末期内径（LVIDd：4.62±0.52和4.31±0.51，P=0.002）均较非TTC组增大；TTC组与非TTC组比较舒张功能参数如E波（P=0.160）、A波（P=0.093），E波减速时间（P=0.098）和E与e′(s)之比（P=0.649）差异均无统计学意义。多因素分析结果显示，cTnT水平升高（OR1.965,95%CI1.122~3.785, P0.001）和正性肌力药物（OR 1.445, 95%CI1.217~4.263, P<0.001）是脓毒症诱发TTC的独立危险因素。结论 cTnT水平升高、正性肌力药物是脓毒症诱发TTC的危险因素，对于这类高风险患者需进行早期监测和预防。

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	葛建辉
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关键词 ：脓毒症, Takotsubo心肌病, 危险因素

作者简介: 葛建辉（1975-），男，主治医师，E-mail:wading1012@163.com。

引用本文:

葛建辉，葛湘军. 脓毒症诱发Takotsubo心肌病危险因素分析[J]. 中国急救医学, 2019, 39(5): 426-430.
Ge Jian-hui, Ge Xiang-jun. Analysis of risk factors for sepsis-induced Takotsubo cardiomyopathy. Chinese Journal of Critical Care Medicine, 2019, 39(5): 426-430.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.05.006 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I5/426

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