Effect of levosimendan on myocardial injury in patients with sepsis / 中国基层医药

ABSTRACT

Objective:To investigate the effect of levosimendan on myocardial injury in patients with sepsis.Methods:Eighty-two patients with sepsis complicated by myocardial injury who received treatment in Yinzhou Second Hospital from June 2015 to September 2017 were included in this study. They were randomly assigned to receive either dobutamine treatment (control group, n = 41) or levosimendan treatment (study group, n = 41) based on conventional basic treatment. Before and after treatment, serum levels of heart-type fatty acid-binding protein (H-FABP), cardiac troponin I (cTnI), N-terminal pro brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LEVF), Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II) score, intensive care unit (ICU) stay, and 28-day mortality were compared between the control and study groups. Results:Before treatment, there were no significant differences in serum levels of H-FABP, cTnI, and NT-proBNP as well as LVEF and APACHE II score between the control and study groups (all P > 0.05). At 6 hours after treatment, serum levels of H-FABP, cTnI, and NT-proBNP in the control and study groups [(26.22 ± 7.22) μg/L vs. (39.93 ± 9.85) μg/L, (25.97 ± 6.93) μg/L vs. (34.86 ± 8.55) μg/L, (0.004 ± 0.002) μg/L vs. (1.580 ± 0.360) μg/L, (0.003 ± 0.003) μg/L vs. (0.760 ± 0.210) μg/L, (1 561.73 ± 633.70) ng/L vs. (2 570.06 ± 747.95) ng/L, (1 602.28 ± 681.45) ng/L vs. (2 225.53 ± 585.14) ng/L] were significantly increased compared with before treatment ( t = 7.188, 5.172, 28.031, 23.079, 6.586, 4.443, all P < 0.05). After treatment, serum levels of H-FABP, cTnI, and NT-proBNP in the study group were significantly lower than those in the control group ( t = 2.489, 12.598, 2.323, all P < 0.05). In each group, serum level of H-FABP at 72 hours after treatment was significantly lower than that at 6 hours after treatment [(39.93 ± 9.85) μg/L vs. (6.28 ± 1.07) μg/L, (34.86 ± 8.55) μg/L vs. (5.82 ± 1.88) μg/L], serum levels of cTnI and NT-proBNP at 72 hours after treatment were significantly increased compared with those at 6 hours after treatment [(1.58 ± 0.36) μg/L vs. (2.72 ± 0.55) μg/L, (0.76 ± 0.21) μg/L vs. (1.78 ± 0.49) μg/L, (2 570.06 ± 747.95 ) ng/L vs. (3 623.27 ± 1 105.28) ng/L, (2 225.53 ± 585.14) ng/L vs. (3 128.08 ± 1 098.07) ng/L, t = 11.105, 12.251, 5.053, 4.645, all P < 0.05). At 72 hours after treatment, serum levels of cTnI and NT-proBNP levels in the control group were significantly higher than those in the study group ( t = 8.171, 2.035, both P < 0.05). At 72 hours after treatment, there was no significant difference in serum H-FABP level between the control and study groups ( P > 0.05). At 72 hours after treatment, APACHE II score in each group was significantly decreased and LVEF in each group was significantly increased compared with before treatment ( t = 7.718, 11.380, 9.049, 9.501, all P < 0.05). The change in APACHE II score at 72 hours after treatment relative to before treatment in the study group was more obvious than that in the control group ( t = 2.583, P < 0.05). At 72 hours after treatment, there were no significant differences in LVEF, ICU stay and 28-day mortality between the control and study groups (all P > 0.05). Conclusion:Levosimendan can reduce the serum levels of H-FABP, cTnI and NT-proBNP as well as APACHE II score in patients with sepsis, increase serum level of LVEF, and alleviate myocardial injury.