摘要
目的 探究脓毒症合并心肌损伤患者血清组织纤溶酶原激活物-纤溶酶原激活物抑剂-1复合物(t-PAI-C)、肝素结合蛋白(HBP)、外周血高迁移率组蛋白B1(HMGB1)水平与其预后的关系.方法 回顾性分析2020年3月至2023年3月蚌埠医学院第一附属医院收治的105例脓毒症合并心肌损伤患者的临床资料,依据患者治疗后28 d存活情况将其分为存活组与死亡组.比较两组临床资料(性别、年龄、体重指数、感染部位、平均动脉压、射血分数)、血清心肌肌钙蛋白I(cTnI)、t-PAI-C、HBP、HMGB1水平以及急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)评分,分析影响脓毒症合并心肌损伤患者预后的影响因素;探究t-PAI-C、HBP、HMGB1水平与cTnI、APACHE Ⅱ评分的相关性;绘制受试者工作特征(ROC)曲线分析t-PAI-C、HBP、HMGB1诊断脓毒症合并心肌损伤患者预后的价值.结果 脓毒症合并心肌损伤患者随访期间出现死亡30例(28.57％),存活75例(71.43％).死亡组患者的cTnI、t-PAI-C、HBP、HMGB1 水平以及 APACHE Ⅱ 评分分别为(1.58±0.43)μg/L、(16.75±4.00)ng/mL、(45.68±9.25)ng/mL、(125.00±20.18)μg/L、(17.63±2.66)分,均高于存活组[(0.65±0.11)μg/L、(13.20±2.68)ng/mL、(38.00±8.63)ng/mL、(96.69±11.25)μg/L、(1 1.50±1.68)分],差异均有统计学意义(P＜0.05).cTnI、t-PAI-C、HBP、HMGB1 以及APACHE Ⅱ评分均为影响脓毒症合并心肌损伤患者预后的独立危险因素(P＜0.05).t-PAI-C、HBP、HMGB1与cTnI、APACHE Ⅱ评分之间均呈正相关(P＜0.05).t-PAI-C、HBP、HMGB1三者联合诊断脓毒症合并心肌损伤患者预后的曲线下面积(AUC)为0.950(0.889～0.983),敏感度与特异度分别为83.33％和93.33％,诊断效能均优于单一的 t-PAI-C、HBP、HMGB1 指标(P＜0.05).结论 t-PAI-C、HBP、HMGB 1 水平与 cTnI、APACHE Ⅱ 评分相关性较好,可作为临床诊断脓毒症合并心肌损伤的潜在生物学标记物,三者联合预测脓毒症合并心肌损伤患者预后效能较好.
Abstract
Objective To investigate the relationship between serum tissue plasminogen activator,plasminogen activator inhibitor-1 complex(t-PAI-C),heparin binding protein(HBP)and peripheral blood high mobility histone B1(HMGB1)levels and prognosis in patients with sepsis complicated with myocardial injury.Methods The clinical data of 105 patients with sepsis complicated with myocardial injury admit-ted to the First Affiliated Hospital of Bengbu Medical College from March 2020 to March 2023 were restrospectively analyzed.Patients were divided into survival group and death group according to their 28 d survival rate after treatment.The clinical data(gender,age,body mass index,site of infection,mean arterial pressure,ejection fraction),serum cardiac troponin I(cTnI),t-PAI-C,HBP,HMGB1 levels,and acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ)scores were compared between the two groups,the influencing factors on the prognosis of patients with sepsis combined with myocardial injury were analyzed,the correlation between t-PAI-C,HBP,HMGB1 levels and cTnI and APACHE Ⅱ scores were explored,and the prognostic value of t-PAI-C,HBP,and HMGB1 in diagnosing sepsis combined with myocardial inju-ry patients were analyzed by drawing receiver operating characteristic(ROC)curves.Results During follow-up,30 cases(28.57％)died and 75 cases(71.43％)survived in patients with sepsis complicated with myocardial injury.The levels of cTnI,t-PAI-C,HBP,HMGB1 and APACHE Ⅱ scores of patients in the death group were(1.58±0.43)μg/L,(16.75±4.00)ng/mL,(45.68±9.25)ng/mL,(125.00±20.18)μg/L,(17.63±2.66)points,respectively,which were higher than those in the survival group[(0.65±0.11)μg/L,(13.20±2.68)ng/mL,(38.00±8.63)ng/mL,(96.69±11.25)μg/L,(11.50±1.68)points],the differences were statistically significant(P＜0.05).The cT-nI,t-PAI-C,HBP,HMGB1 and APACHE Ⅱ scores were independent risk factors for the prognosis of patients with sepsis complicated with myocardial injury(P＜0.05).T-PAI-C,HBP,and HMGB1 showed a positive correlation with cTnI and APACHE Ⅱ scores(P＜0.05).The prognosis area under the curve(AUC)of t-PAI-C,HBP and HMGB1 in the combined diagnosis of sepsis complicated with myocardial in-jury were 0.950(0.889-0.983),and the sensitivity and specificity were 83.33％and 93.33％.The diagnostic efficacy were better than that of single t-PAI-C,HBP and HMGB1 indexes(P＜0.05).Conclusion T-PAI-C,HBP and HMGB1 levels have a good correlation with cT-nI and APACHE Ⅱ scores,which can be used as potential biological markers for clinical diagnosis of sepsis complicated with myocardial injury.The combination of the three can predict the prognosis of patients with sepsis complicated with myocardial injury.
基金项目
安徽省自然科学基金项目(210808QH324)
蚌埠医学院自然科学重点项目(2021byzd157)
蚌埠医学院自然科学重点项目(BYKY2019118ZD)
NETL
NSTL
维普
万方数据