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投稿时间：2023-11-02 网络发布日期：2024-11-20
投稿时间：2023-11-02 网络发布日期：2024-11-20
中文摘要: 目的 探讨在脓毒症心肌损伤患者中白蛋白/纤维蛋白原比值（AFR）的水平及其与预后的关系。方法 采用前瞻性临床观察研究，收集2022年2月至2023年4月徐州医科大学附属连云港医院收治的101例脓毒症患者为研究对象。根据是否发生心肌损伤分为心肌损伤组（46例）和心功能正常组（55例），记录两组患者的基本临床资料，并于入科24 h内采集外周血检测白蛋白、纤维蛋白原、氨基末端B型利钠肽前体（NT-proBNP）、高敏肌钙蛋白I（hsTnI）、降钙素原（PCT）、急性生理学和慢性健康状况评分（APACHE）Ⅱ及序贯器官衰竭评分（SOFA）。随访28 d，记录患者生存情况。采用logistic回归分析脓毒症发生心肌损伤的危险因素；受试者工作特征（ROC）曲线分析AFR对脓毒症心肌损伤的诊断效能。结果 与心功能正常组相比，心肌损伤组的白蛋白、AFR水平降低，NT-proBNP、hsTnI、APACHEⅡ评分及纤维蛋白原水平升高（P＜0.05）。AFR升高为脓毒症发生心肌损伤的独立保护因素（OR=0.547， 95%CI: 0.384~0.779， P=0.001）。当AFR截断值为7.07时，其单独诊断脓毒症心肌损伤的曲线下面积（AUC）为0.791（95%CI： 0.693~0.888），但联合hsTnI、NT-proBNP和APACHEⅡ评分后诊断价值最高，AUC为0.933（95%CI： 0.887~0.978）。AFR 低水平（AFR≤7.07）脓毒症患者的28 d生存率明显低于AFR高水平（AFR＞7.07）脓毒症患者（P＜0.05）。结论 AFR在一定程度上可以预测脓毒症患者心肌损伤的发生及28 d死亡风险。
中文关键词: 脓毒症 心肌损伤 白蛋白/纤维蛋白原比值 生存率
Abstract:Objective To investigate the level of albumin/fibrinogen ratio (AFR) and its relationship with prognosis in patients with septic myocardial injury. Methods From February 2022 to April 2023, a prospective clinical observational study was conducted to collect 101 patients with sepsis in Lianyungang Hospital Affiliated to Xuzhou Medical University as study subjects. They were divided into myocardial injury group (46 cases) and normal cardiac function group (55 cases) according to whether myocardial injury occurred. The basic clinical data of the two groups were recorded, and peripheral blood was collected within 24 h of admission to test for albumin, fibrinogen, amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity troponin I (hsTnI), calcitoninogen (PCT), acute physiology and chronic health evaluation (APACHEⅡ), and sequential organ failure assessment (SOFA). Survival of patients was recorded at 28 days of follow-up. Logistic regression was used to analyze the independent risk factors of septic myocardial injury, ROC curve was used to analyze the clinical diagnostic efficacy of AFR in septic myocardial injury. Results Compared with normal cardiac function group, the levels of albumin and AFR were significantly reduced, while the NT-proBNP, hsTnI, APACHEⅡ scores, and fibrinogen were significantly increased in myocardial injury group (P＜0.05). Elevated AFR was an independent protective factor for myocardial injury in sepsis (OR=0.547, 95%CI: 0.384-0.779, P=0.001). When the AFR cutoff value was 7.07, the AUC for the diagnosis of septic myocardial injury was 0.791 (95%CI: 0.693-0.888), but the combination of hsTnI, NT-proBNP and APACHEⅡ scores had the highest diagnostic value, with an AUC of 0.933 (95%CI: 0.887-0.978).The 28-day survival of sepsis patients with low AFR expression (AFR≤7.07) was significantly lower than that of sepsis patients with high AFR expression (AFR＞7.07, P＜0.05).Conclusion To some extent, AFR can predict the occurrence of myocardial injury and the risk of 28-day death in patients with sepsis.
文章编号： 中图分类号：R631 文献标志码：A
基金项目:江苏省科技计划项目（BE2020670）
附件
| 作者 | 单位 |
| 田雪艳 | 1. 徐州医科大学附属连云港医院急诊医学科，江苏 连云港 222000 |
| 俞典 | 2. 南京医科大学连云港临床医学院急诊医学科，江苏 连云港 222000 |
| 李小民 | 1. 徐州医科大学附属连云港医院急诊医学科，江苏 连云港 222000 |
| 陈雪峰 | 1. 徐州医科大学附属连云港医院急诊医学科，江苏 连云港 222000 |
引用文本：
田雪艳,俞典,李小民,等.白蛋白/纤维蛋白原比值与脓毒症患者心肌损伤的相关性及预后价值[J].中国临床研究,2024,37(11):1709-1713.
田雪艳,俞典,李小民,等.白蛋白/纤维蛋白原比值与脓毒症患者心肌损伤的相关性及预后价值[J].中国临床研究,2024,37(11):1709-1713.