中文摘要：

目的：探讨各种心肌损伤标志物联合APACHEⅡ评分在感染性休克患者预后判断中的价值。方法收集我院ICU 2013－01～2014－10期间收治的82例感染性休克（排除了合并有慢性心力衰竭、急性冠脉综合征、慢性肾衰竭和癌症等基础疾病）患者的临床资料。监测患者确诊感染性休克当天血清肌红蛋白（ MYO ）、肌酸激酶同工酶（ CK－MB ）、氨基末端脑利钠肽（ NT－proBNP）及血清肌钙蛋白（ cTnT）水平，计算确诊当天APACHEⅡ评分，根据APACHEⅡ评分预测其死亡危险率，并随访患者28 d生存率。分析血清MYO、CK－MB、NT－proBNP、cTnT水平与感染性休克患者APACHEⅡ评分及预后的关系。结果感染性休克患者中分别有45．1％、63．4％、78．0％和93．9％的患者血清CK－MB、cTnT、MYO和NT－proBNP水平超过正常值；其中，感染性休克死亡组患者血清MYO、CK－MB、cTnT水平明显高于存活组患者（ P＜0．05），发生MODS的感染性休克患者组血清MYO、CK－MB、NT－proBNP水平及死亡率均明显高于非MODS组的患者（P＜0．05）。进一步研究发现，血清MYO、CK－MB、cTnT及APACHEⅡ评分对预测感染性休克患者的死亡风险具有统计学意义，ROC曲线下面积分别为0．673、0．703、0．719及0．851（P＜0．05）；血清MYO、CK－MB、cTnT和NT－proBNP联合预测患者预后的ROC曲线下面积为0．749（P＜0．05），而心肌损伤标志物联合APACHEⅡ评分预测患者预后的ROC曲线下面积为0．874（P＜0．05），明显高于单用心肌损伤标志物组及单用APACHEⅡ评分组。结论感染性休克伴MODS患者及死亡患者血清心肌损伤标志物明显升高，心肌损伤标志物是感染性休克患者预后评估指标的有益补充，联合APACHEⅡ评分对患者预后的评估价值更大。

英文摘要：

Objective The aim of this study was to investigate the significance of myocardial injury markers combined with APACHEⅡscore in predicting the prognosis of patients with septic shock. Methods Clinical data of 82 patients with septic shock were analyzed retrospectively.The serum concentration of MYO, CK-MB, NT-proBNP, cTnT in patients with septic shock were measured on the day of definite diagnosis.The APACHEⅡscore was calculated and the risk of death was predicted according to APACHEⅡ score, and the survival rate of 28 days were followed up.The relationship between MYO, CK-MB, NT-proBNP, cTnT level and prognosis was analyzed.Results In patients with septic shock, 45.1% of patients had elevated serum CK-MB, 63.4% of patients had elevated serum cTnT, 78.0%of patients had elevated serum MYO, 93.9%of patients had elevated serum NT-proBNP.Compared with survival group, serum levels of MYO, CK-MB and cTnT were higher in death group （P〈0.05）.In patients with MODS, the serum levels of MYO, CK-MB, NT-proBNP and mortality were higher than those in patients without MODS （P〈0.05）.MYO, CK-MB, cTnT and APACHEⅡscore had statistical significance in predicting death （ area under ROC curve was 0.673, 0.703, 0.719 and 0.851 respectively, P〈0.05）.The area under ROC curve of MYO, CK-MB, cTnT and NT-proBNP to predict death together was 0.749 （P〈0.05）.The area under ROC curve was 0.874 （P〈0.05） when MYO, CK-MB, cTnT and NT-proBNP were combined with APACHEⅡscore, which was higher than APACHEⅡscore or myocardial injury markers alone in predicting death. Conclusion Serum levels of myocardial injury markers were higher in death group and group with MODS.MYO, CK-MB and cTnT have predictive effect for the prognosis of patients with septic shock. High serum MYO, CK-MB, cTnT predicts higher mortality in patients with septic shock.Myocardial injury markers combined with APACHEⅡ score have important predictive value for the prognosis of patients with septic shock.