脓毒症患儿心功能与血清TNF-α、IL-1β水平的相关性分析

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摘要目的探讨脓毒症患儿心功能与血清肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）水平的相关性。方法选取2016年10月—2019年10月湖南省儿童医院（以下简称“我院”）急诊综合二科收治的126例脓毒症患儿，分为非心肌损伤组（A组，49例）与心肌损伤组（B组，77例）。根据左心室射血分数（LVEF），将B组分成轻（B1组，23例）、中（B2组，34例）、重（B3组，20例）心肌损伤组。另选取同期我院体检健康50名儿童为对照组。比较各组心功能指标及血清TNF-α、IL-1β水平的差异。结果 A、B组急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、血清心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、N-末端B型钠尿肽前体（NT-proBNP）、TNF-α、IL-1β均高于对照组，LVEF、二尖瓣舒张早期充盈峰速度E峰/心房收缩期最大流速A峰（E/A）均低于对照组，差异有统计学意义（P ＜ 0.05）；且A组与B组上述指标组间比较，差异有统计学意义（P ＜ 0.05）。不同心肌损伤程度患儿APACHEⅡ、LVEF、E/A及cTnI、CK-MB、NT-proBNP、TNF-α、IL-1β比较，差异有高度统计学意义（P ＜ 0.01）；B2、B3组APACHEⅡ、cTnI、CK-MB、NT-proBNP、TNF-α、IL-1β均高于B1组，差异有统计意义（P ＜ 0.05）；且B2、B3组各指标比较，差异有统计学意义（P ＜ 0.05）。脓毒症心肌损伤患儿血清TNF-α、IL-1β与LVEF、E/A呈负相关（P ＜ 0.01），而与血清cTnI、CK-MB、NT-proBNP呈正相关（P ＜ 0.01）。血清TNF-α、IL-1β的最佳截断值分别取80.26、8.83 pg/mL时，敏感度和特异度分别为87.6%和93.5%、90.5%和93.5%；四者联合检测时敏感度和特异度为97.6%和94.1%。结论血清TNF-α、IL-1β水平能反映小儿脓毒症心肌损伤，可作为小儿脓毒症心肌损伤早期诊断的可靠标志物，与心功能指标联合检测能提高准确性。

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	罗兰曾方玲隆彩霞陈艳瑛周海银

关键词 ：儿童, 脓毒症, 心肌损伤, 炎症因子

Abstract：Objective To explore the correlation between heart function and serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels in children with sepsis. Methods From October 2016 to October 2019, a total of 126 children with sepsis admitted to the Second Department of Emergency of Hu′nan Children′s Hospital (hereinafter referred to as “our hospital”) were divided into non-myocardial injury group (group A, 49 cases) and myocardial injury group (group B, 77 cases). According to the left ventricular ejection fraction (LVEF), the group B was divided into mild (group B1, 23 cases), medium (group B2, 34 cases), and severe (group B3, 20 cases) myocardial injury group. In the same period, a total of 50 children in our hospital were selected as the control group. The differences in the cardiac function indexes and serum TNF-α and IL-1β levels of each group were compared. Results Acute physiology and chronic health scoring system Ⅱ (APACHE Ⅱ) score, serum cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), N-terminal B-type natriuretic peptide pre Body (NT-proBNP), TNF-α, IL-1β were higher than those in the control group, while LVEF, early mitral valve filling peak velocity E peak / atrial systolic maximum flow velocity A peak (E/A) were lower than those in the control group, and the differences were statistically significant (P < 0.05); moreover, the differences between the above-mentioned index groups between group A and group B were statistically significant (P < 0.05). Comparison of APACHE Ⅱ, LVEF, E/A and cTnI, CK-MB, NT-proBNP, TNF-α, IL-1β in children with different levels of myocardial injury, and the differences were highly statistically significant (P < 0.01); APACHEⅡ, cTnI, CK-MB, NT-proBNP, TNF-α and IL-1β in group B2 and group B3 were all higher than those in group B1, and the differences were statistically significant (P < 0.05); in addition, the differences between the index in B2 group and B3 group were statistically significant (P < 0.05). Serum TNF-α and IL-1β in children with septic myocardial injury were negatively correlated with LVEF and E/A (P < 0.01), while there were positively correlated with serum cTnI, CK-MB, and NT-proBNP (P < 0.01). When the best cut-off values of TNF-α and IL-1β were 80.26 pg/mL and 8.83 pg/mL, respectively, the sensitivity and specificity were 87.6% and 93.5%, 90.5% and 93.5%, respectively; when the four were combined, the sensitivity and specificity were 97.6% and 94.1%. Conclusion Serum TNF-α and IL-1β levels can reflect myocardial damage in children with sepsis, and can be used as reliable markers for the early diagnosis of myocardial damage in children with sepsis. Combined detection with cardiac function indicators can improve accuracy.

Key words： Children Sepsis Myocardial injury Inflammatory factors

基金资助:湖南省卫生计生委科研计划课题项目（B201803 71）。

作者简介: 罗兰（1983-），女，硕士；研究方向：儿童急救及重症医学。

引用本文:

罗兰曾方玲隆彩霞陈艳瑛周海银. 脓毒症患儿心功能与血清TNF-α、IL-1β水平的相关性分析[J]. 中国医药导报, 2020, 17(30): 16-19,23.
LUO Lan ZENG Fanglin LONG Caixia CHEN Yanying ZHOU Haiyin. Correlation analysis of heart function and serum TNF-α, IL-1β levels in children with sepsis. 中国医药导报, 2020, 17(30): 16-19,23.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I30/16

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