Abstract:

Objective　To investigate the relationship of procalcitonin (PCT) and cardiac troponin (cTn) with the occurrence of complications and prognosis of patients with infective endocarditis (IE). Methods　Two hundred patients with IE treated at Tongchuan People's Hospital between May 2019 and December 2023 were selected as the study objects. All the patients were followed up regularly for six months outside the hospital. According to whether they had complications, the patients were divided into an observation group and a control group. There were 101 males and 49 females in the control group; they were (58.66±4.66) years old; their disease course was (2.98±0.41) years. There were 27 males and 23 females in the observation group; they were (58.44±4.36) years old; their disease course was (3.03±0.48) years. According to whether they recurred or died, the patients were divided into a good prognosis group and a poor prognosis group. The serum levels of PCT and cTn were compared between the observation group and the control group and between the good prognosis group and the poor prognosis group by t test. The independent factors influencing the patients' prognosis were analyzed by the binary logistic regression. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacies of PCT and cTn. Results　Among the 200 patients, 50 cases (25.00%) had complications, and were set as an observation group; the other 150 (75.00%) did not have complications, and were set as a control group. Among the 200 patients, 60 cases (30.00%) recurred or died, and were set as a poor prognosis group; the other 140 cases (70.00%) did not recurred or died, and were set as a good prognosis group. The levels of PCT and cTn in the observation group were higher than those in the control group [(0.35±0.02) μg/L vs. (0.04±0.01) μg/L and (0.29±0.03) μg/L vs. (0.08±0.01) μg/L; both P<0.05]. The levels of PCT and cTn in the good prognosis group were lower than those in the poor prognosis group [(0.32±0.02) μg/L vs. (0.04±0.01) μg/L and (0.30±0.03) μg/L vs. (0.07±0.01) μg/L; both P<0.05]. The Pearson correlation analysis showed that PCT and cTn were positively correlated with the occurrence of complications and poor prognosis in the patients (r=0.731 and 0.628; r=0.718 and 0.669; all P<0.05). PCT (OR=2.356, 95%CI 1.421-4.413), and cTn (OR=2.354, 95%CI 1.204-4.601) were independent risk factors for poor prognosis in the patients (both P<0.05). Conclusion　High PCT and cTn levels are closely related to the occurrence of complications and prognosis of patients with IE and are adverse factors affecting the prognosis of patients with IE.

Key words: Infective endocarditis,  , PCT,  , cTn,  , Incidence rate of complications,  , Treatment response

摘要：

目的　探讨降钙素原（procalcitonin，PCT）、心肌肌钙蛋白（cardiac troponin，cTn）与感染性心内膜炎（infective endocarditis，IE）患者并发症发生情况及预后的关系。方法　选取2019年5月至2023年12月铜川市人民医院收治的IE患者200例为研究对象。依据是否存在并发症将研究对象分为观察组与对照组。对照组男101例，女49例，年龄（58.66±4.66）岁，病程（2.98±0.41）年。观察组男27例，女23例，年龄（58.44±4.36）岁，病程（3.03±0.48）年。所有患者均进行为期6个月的定期院外随访，并根据患者是否复发或发生死亡将患者分为预后良好组和预后不良组。比较观察组与对照组、预后良好组与预后不良组血清PCT及cTn水平。采用Pearson相关性分析探讨IE患者PCT、cTn水平与并发症的发生情况及预后的相关性。通过二元logistic回归分析影响IE患者预后的独立危险因素。采用受试者操作特征曲线（receiver operating characteristic curve，ROC）评估相关指标的诊断效能。采用t检验进行统计分析。结果　200例IE患者中，共有50例患者存在并发症（25.00%），将其纳入观察组；150例（75.00%）未发生并发症，将其纳入对照组。200例患者中，60例（30.00%）复发或死亡，将其纳入预后不良组；140例（70.00%）未复发或死亡，将其纳入预后良好组。观察组PCT、cTn水平均高于对照组［（0.35±0.02）μg/L比（0.04±0.01）μg/L、（0.29±0.03）μg/L比（0.08±0.01）μg/L，均P<0.05］。预后良好组PCT、cTn水平均低于预后不良组［（0.32±0.02）μg/L比（0.04±0.01）μg/L、（0.30±0.03）μg/L比（0.07±0.01）μg/L，均P<0.05］。经Pearson相关性分析，PCT、cTn与IE患者并发症的发生及预后不良均呈正相关（r=0.731、0.628；r=0.718、0.669，均P<0.05）。PCT（OR=2.356，95%CI 1.421～4.413）、cTn（OR=2.354，95%CI 1.204～4.601）均为IE患者预后不良的独立危险因素（均P<0.05）。ROC分析结果显示，PCT、cTn水平高对IE患者均存在中等预测价值（均P<0.05）。结论　PCT、cTn水平高与IE患者并发症的发生及预后关系密切，是影响IE患者预后的不良因素。

关键词: 感染性心内膜炎, PCT, cTn, 并发症发生率, 治疗反应