| 王昆仑,莫为春,王润泽,张志华.基于LV-GLS、VISmax与PCT的联合模型对老年脓毒性心肌病的早期预测研究[J].老年医学与保健,2026,32(3):383-387 |
| 基于LV-GLS、VISmax与PCT的联合模型对老年脓毒性心肌病的早期预测研究 |
| Study on early prediction of septic cardiomyopathy in elderly patients based on a combined model of LV-GLS,VISmax and PCT |
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| DOI：10.3969/j.issn.1008-8296.2026.03.011 |
| 中文关键词: 老年 脓毒症 脓毒性心肌病 左室整体纵向应变 早期诊断 |
| 英文关键词: elderly sepsis septic cardiomyopathy left ventricular global longitudinal strain early diagnosis |
| 基金项目:2022-WS-13:上海市金山区医药卫生科技创新资金项目 |
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| 中文摘要: |
| 目的 探讨左室整体纵向应变(LV-GLS)、最大血管活性药物评分(VISmax)与降钙素原(PCT)的联合模型在老年脓毒性心肌病(SCM)早期诊断中的价值.方法 回顾性选取 2022 年 7 月至 2024 年 12 月复旦大学附属金山医院ICU 收治的106 例既往无心功能不全的老年脓毒症患者,以入院时超敏肌钙蛋白Ⅰ(Hs-TnⅠ)≥0.131 μg/L 及氨基末端脑钠肽前体(NT-proBNP)≥3 270 ng/L 为标准,将患者分为 SCM 组(n=33)与非 SCM 组(n=73).于入院当日,液体复苏后第1、3 天检测患者血浆乳酸(Lac)值、PCT 和肌红蛋白(Mb)水平,记录 24 h 的 VISmax 及序贯器官衰竭评估(SOFA)评分,并测定 LV-GLS.采用单因素及多因素 Logistic 回归方法分析筛选老年 SCM 的独立预测因子.结果 与非 SCM 组相比,SCM 组患者各时间点 PCT、Lac、Mb、VISmax 及 SOFA 均升高,LV-GLS 绝对值降低,差异均有统计学意义(P<0.001).多因素 Logistic 回归分析结果显示,VISmax(≥26.11 μg/min)、PCT(≥7.81 μg/L)及 LV-GLS(≥-17.62%)是早期诊断 SCM 的独立预测因素.3 项指标联合预测模型的早期诊断效能最高,其曲线下面积为 0.942,灵敏度为90.9%,特异度为87.7%.结论 LV-GLS、VISmax 与 PCT 联合预测模型对老年 SCM 可能具有优异的早期诊断价值. |
| 英文摘要: |
| Objective To explore the value of a combined model of left ventricular global longitudinal strain(LV-GLS),maximal vasoactive-inotropic score(VISmax)and procalcitonin(PCT)in the early diagnosis of septic cardiomyopathy(SCM)in elderly patients.Methods 106 elderly patients with sepsis without previous heart function impairment and admitted to ICU of Jinshan Hospital Affiliated to Fudan University from July 2022 to December 2024 were retrospectively selected.They were divided into SCM group(n=33)and non-SCM group(n=73)based on the levels of high-sensitivity troponin Ⅰ(Hs-TnⅠ)≥0.131 μg/L and N-terminal pro-brain natriuretic peptide(NT-proBNP)≥3 270 ng/L at admission.The levels of plasma lactate(Lac),PCT,and myoglobin(Mb)were measured on the day of admission and on days 1 and 3 after fluid resuscitation.The 24-h VISmax and sequential organ failure assessment(SOFA)score were recorded,and LV-GLS was measured with two-dimensional speckle tracking technology.Univariate and multivariate Logistic regression analyses were used to identify independent predictive factors.Results Compared with the non-SCM group,the SCM group showed significantly higher levels of PCT,Lac,Mb,VISmax and SOFA scores at all time points,while the absolute value of LV-GLS was significantly lower.All differences were statistically significant(P<0.001).Multivariate Logistic regression analysis identified VISmax(≥26.11 μg/min),PCT(≥7.81 μg/L)and LV-GLS(≥-17.62%)as independent predictors for the early diagnosis of SCM.The combined model of these three indicators demonstrated the highest predictive efficacy for early diagnosis of SCM,with an area under the curve of 0.942,a sensitivity of 90.9%,and a specificity of 87.7%.Conclusion The combined predictive model based on LV-GLS,VISmax and PCT exhibits excellent value in the early diagnosis of SCM in elderly patients. |
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