室壁运动异常患者发生Takotsubo综合征的危险因素分析

Analysis of risk factors for Takotsubo cardiomyopathy in patients with abnormal left ventricular function

摘要:

目的 初步探讨左心功能异常的危重患者触发Takotsubo综合征（TTC）的危险因素和机制。方法 选取2015年3月—2019年3月三亚中心医院重症监护室（ICU）收治的左心功能异常危重患者384例作为研究对象。根据是否符合TTC诊断标准分为TTC组38例和非TTC组346例。收集患者的年龄、性别、体重指数，以及炎症指标、心肌酶谱等实验室参数。观察ICU内发生TTC的危险因素。比较两组患者的住院时间、28 d院内病死率及再住院率。采用多因素Logistic回归模型进行危险因素分析。结果 单因素分析显示TTC组的女性比例升高（P <0.05），此外TTC组除pH值降低外，APACHE Ⅱ、心率、cTnT、NT-proBNP均较非TTC组升高（P <0.05），并且脓毒症、创伤性脑损伤、使用正性肌力药物的构成比高于非TTC组（P <0.05）。多因素Logistic回归分析结果显示脓毒症［R=1.955（95% CI：1.126，4.255）］，创伤性脑损伤［R=1.263（95% CI：1.016，3.549）］是左心功能异常的危重患者触发TTC的独立危险因素（P <0.05）。结论 脓毒症、创伤性脑损伤是危重患者发生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。

Abstract:

Objective To investigate the risk factors and mechanism of triggering Takotsubo cardiomyopathy (TTC) in critical patients with left ventricular dysfunction.Methods A total of 384 critical cases of abnormal left heart function in the ICU from March 2015 to March 2019 were selected. The cases were divided into TTC group and non-TTC group according to whether it was consistent with TTC diagnosis. The patients' age, gender, body mass index, inflammatory parameters, myocardial enzyme patterns, and other laboratory parameters were collected. The primary endpoint was the risk of developing TTC in the ICU. Secondary endpoints were length of stay in hospital, 28 days of in-hospital mortality and rehospitalization rates. Statistically significant variables in univariate analysis are introduced into multivariate logistic regression for risk factor analysis.Results There were 38 cases in TTC group and 346 cases in non-TTC group. Univariate analysis showed that the proportion of women in the TTC group was significantly higher (P < 0.05). In addition to the decrease in pH value, the heart rate, APACHE II, cTnT, and NT-proBNP were significantly higher in the TTC group than in the non-TTC group (P < 0.05). The proportions of sepsis, traumatic brain injury (TBI), and positive inotropic drugs were significantly higher than those of non-TTC patients (P < 0.05). Multivariate analysis showed sepsis [R = 1.95, (95% CI: 1.13, 4.26)] and TBI [R = 1.263, (95% CI: 1.016, 3.549)] were independent risk factors for triggering TTC in critical patients with left cardiac dysfunction.Conclusions Sepsis and TBI are risk factors for TTC in critical patients. Early surveillance and prevention are needed for these high-risk patients.