摘要
目的 探讨血清高迁移率族蛋白B1(HMGB1)、糖原磷酸化酶同工酶BB(GPBB)与脓毒症患儿心肌损伤指标及预后相关性.方法 回顾性选取2020年6月至2023年6月电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院收治的100例脓毒症患儿,参考有无心肌损伤分为有损伤组(n=50)与无损伤组(n=50).比较两组患儿心肌损伤指标[心肌肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)、肌红蛋白]与血清HMGB1、GPBB水平,采用Pearson相关系数分析对心肌损伤指标与HMGB1、GPBB相关性;同时,参考有损伤组患儿1个月预后状况将其划分为存活组和死亡组,经单因素和多因素Logistic回归分析影响脓毒症患儿预后的因素.结果 有损伤组患儿血清cTnⅠ、CK-MB、肌红蛋白、HMGB1、GPBB 水平分别为(0.24±0.04)μg/L、(23.19±5.52)U/L、(99.64±13.15)μg/L、(152.54±29.23)pg/mL、(24.34±2.79)ng/mL,均明显高于无损伤组[(0.09±0.03)μg/L、(13.23±4.69)U/L、(31.05±8.78)μg/L、(137.26±24.25)pg/mL、(9.83±1.98)ng/mL],差异均有统计学意义(P＜0.05).cTnⅠ、CK-MB、肌红蛋白水平与HMGB1、GPBB水平呈正相关(P＜0.05).单因素分析显示,性别、年龄、体重指数、病因、白蛋白、总胆红素、白细胞计数等与患儿预后无关,差异均无统计学意义(P＞0.05);脓毒症休克比率、APACHE Ⅱ评分、SOFA评分、血肌酐、尿素氮、前白蛋白、cTnⅠ、HMGB1及GPBB水平均与患儿预后显著相关,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,cTnⅠ水平过高、HMGB1水平过高、GPBB水平过高、伴发脓毒症休克和APACHE Ⅱ评分过高是影响脓毒症患儿预后的危险因素(P＜0.05).结论 脓毒症心肌损伤患儿血清HMGB1、GPBB水平均显著上升,高水平HMGB1、GPBB与脓毒症心肌损伤密切相关,且是脓毒症心肌损伤患儿预后不良的危险因素.及时、精准监测HMGB1、GPBB水平变化有益于防治脓毒症心肌损伤及改善预后.
Abstract
Objective To explore the correlation between serum high mobility group protein B1(HMGB 1),glycogen phosphorylase isoenzyme BB(GPBB)and myocardial injury index and prognosis in children with sepsis.Methods A total of 100 children with sepsis admitted to Women and Children's Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu Women and Children's Central Hospital,from June 2020 to June 2023 were retrospectively selected and divided into the injury group(n=50)and the non-injury group(n=50)according to myocardial injury.Myocardial injury indexes[myocardial troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),myoglobin]and HMGB1 and GPBB levels of the two groups were compared,and Pearson correlation coefficient was selected to correlate my-ocardial injury indexes with HMGB1 and GPBB.At the same time,the children in group A were divided into survival group and death group ac-cording to the 1-month prognosis,and the factors affecting the prognosis of children with sepsis were analyzed by univariate and multivariate logis-tic regression analysis.Results The levels of serum cTnⅠ,CK-MB,myoglobin,HMGB1 and GPBB in the injury group were(0.24±0.04)μg/L,(23.19±5.52)U/L,(99.64±13.15)μg/L,(152.54±29.23)pg/mLand(24.34±2.79)ng/mL,respectively,which were sig-nificantly higher than those in the non-injury group[(0.09±0.03)μg/L,(13.23±4.69)U/L,(31.05±8.78)μg/L,(137.26±24.25)pg/mL,(9.83±1.98)ng/mL],the differences were statistically significant(P＜0.05).cTnⅠ,CK-MB and myoglobin levels were positively correlated with HMGB1 and GPBB levels(P＜0.05).Univariate analysis showed that gender,age,body mass index,etiology,albumin,total bilirubin and white blood cell count were not related to the prognosis of children,and the differences were not statistically significant(P＞0.05).The ratio of septic shock,APACHE Ⅱ score,SOFA score,serum creatinine,urea nitrogen,prealbumin,cTnⅠ,HMGB1 and GPBB levels were significantly correlated with the prognosis of children,and the differences were statistically significant(P＜0.05).Multivariate Logistic regres-sion analysis showed that high cTnⅠ level,high HMGB1 level,high GPBB level,septic shock and high APACHE Ⅱ score were risk factors affect-ing the prognosis of children with sepsis(P＜0.05).Conclusion The serum levels of HMGB 1 and GPBB increased significantly in children with septic myocardial injury,and high levels of HMGB 1 and GPBB are closely related to septic myocardial injury,and are risk factors for poor prognosis of septic myocardial injury.Timely and accurate monitoring of HMGB1 and GPBB levels is beneficial to the prevention and treatment of myocardial injury in sepsis and the improvement of prognosis.
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