张娈娈,王奇坤,陈德,周荣



脓毒症患者血浆可溶性晚期糖基化终末产物受体水平与心功能的关系

张娈娈,王奇坤,陈德,周荣

摘要

关键词脓毒症；利钠肽，脑；心脏功能试验；糖基化终产物，高级

作者单位：730000，甘肃省兰州市，兰州大学第一医院 急诊科

Relationship Between Plasma Levels of Soluble Receptor of Advanced Glycosylation End Products and Cardiac Function in Patients With Sepsis

ZHANG Luan-luan, WANG Qi-qun, CHEN De, ZHOU Rong.
Department of Emergency, First Hospital of Lanzhou University, Lanzhou (730000), Gansu, China
Corresponding Author: ZHOU Rong, Email: zhourong99@163.com

Abstract

Objective: To explore the relationship between plasma levels of soluble receptor of advanced glycation end products (sRAGE), brain natriuretic peptide (BNP) and cardiac function in patients with sepsis.

Methods: A total of 83 sepsis patients treated in our hospital from 2014-01 to 2015-06 were studied. Plasma levels of sRAGE, BNP were examined at 24 h after admission and they were evaluated by APACHEII scores. According to BNP levels, the patients were divided into 2 groups: Normal cardiac function group, the patients with BNP<500 pg/ml, n=32 and Cardiac dysfunction group, the patients with BNP ≥ 500 pg/ml, n=51. The cardiac function as stroke volume (SV), LVEF, minute volume, E/A were examined by echocardiography. The above indexes were analyzed and compared between 2 groups, the relationship between plasma levels of sRAGE and the occurrence of sepsis was assessed by Logistic regression analysis.

Results: Compared with Normal cardiac function group, the patients in Cardiac dysfunction group presented decreased SV, LVEF, minute volume and E/A; increased APACHEII scores and sRAGE, all P<0.01. Plasma levels of sRAGE in sepsis patients were positively related to BNP (r=0.90, P<0.05) and APACHEII scores (r=0.85, P<0.05). Logistic regression analysis indicated that plasma levels of sRAGE (OR=1.019, 95% CI 1.004-1.035, P<0.05) was independently related to cardiac function in patients with sepsis.

Conclusion: Plasma levels of sRAGE were independently related to cardiac function in patients with sepsis.

Key words Sepsis; Natriuretic peptide, brain; Heart function tests; Glycosylation end product, advenced

(Chinese Circulation Journal, 2016,31:73.)

脓毒症是指由感染引起的全身炎症反应综合征（SIRS），为重症监护病房（ICU）常见疾病之一，占ICU疾病种类的10%[1]，其死亡率占发达国家总死亡率的9%，成为死亡率仅次于心脏疾病与癌症后排名第三的疾病[2]。脓毒症所致心肌损伤（SIMD）在脓毒症早期即可出现，心脏为脓毒症易损靶器官之一[3]。Landesberg等[4]考虑从血液的炎症因子找出SIMD的发生机制，但结果并未找到与脓毒症患者心功能障碍密切相关的炎症因子。可溶性晚期糖基化终末产物受体（sRAGE）是晚期糖基化终末产物受体（RAGE）的内源分泌型，缺乏胞内段和膜镶嵌区，通过与配体竞争性结合，从而减少促炎、促凝和生物氧化应激反应的作用，并且可以通过阻碍血管通透性增加和氧化应激反应，对机体的多种病理状态具有保护作用[5]。现已有大量研究表明sRAGE参与炎症反应同时亦涉及心功能诊断及预后[6，7]，但对于血浆sRAGE水平与脓毒症患者心功能的关系研究较少且具有争议性。APACHEⅡ评分为目前大量研究表明与重症患者病情严重程度密切相关、在ICU使用颇广的评分系统之一[8，9]。本研究对2014-01 至2015-03收治于我院ICU的83例脓毒症患者的sRAGE、B型利钠肽（BNP）水平、APACHEⅡ评分及每搏输出量、左心室射血分数（LVEF）、每分输出量和舒张早期血流峰速度/舒张晚期血流峰速度（E/A）比值进行分析，探讨血浆sRAGE水平与脓毒症患者心功能的关系。……