摘要
目的 评估血管紧张素转换酶抑制剂(angiotensin-converting enzyme inhibitor,ACEI)对脓毒症心肌损伤(sepsis-induced myocardial injury,SIMI)患者28天全因死亡率的影响,探讨其潜在治疗价值。方法 本研究基于美国重症监护医学信息数据库Ⅳ(MIMIC-Ⅳ),筛选符合条件的SIMI患者2450例,分为ACEI组和未使用ACEI组。采用倾向性评分匹配(PSM)方法减少基线偏倚,并以28天全因死亡率为主要结局指标。通过Kaplan-Meier(K-M)曲线、多因素Cox回归及亚组分析评估ACEI的作用。此外,收集首都医科大学附属北京朝阳医院的114例SIMI患者进行外部验证。结果 在PSM调整前后,研究共纳入2450例和1042例患者。PSM后,K-M曲线显示,ACEI组28天病死率显著低于未使用ACEI组(P<0.001)。多因素Cox回归分析显示,ACEI的使用显著降低28天全因死亡率[风险比(HR)=0.56,95%置信区间(CI)0.42~0.74,P<0.001]。亚组分析显示,ACEI的治疗效果在不同年龄、性别和基础疾病等亚组中一致(交互作用P>0.05)。此外,不同种类ACEI对28天全因死亡率的影响差异无统计学意义(P>0.05)。外部验证共纳入114例SIMI患者,K-M曲线显示,ACEI的使用与显著降低的28天累积病死率相关(P=0.0017);多变量Cox回归分析进一步支持了ACEI的保护作用,显示其使用显著降低28天全因死亡率(HR=0.22,95%CI 0.05~0.91,P=0.036)。结论 ACEI的使用与SIMI患者28天全因死亡率的显著降低相关,支持其潜在治疗干预的价值。
Objective To evaluate the effect of angiotensin-converting enzyme inhibitors(ACEI)on the 28-day all-cause mortality in the patients with sepsis-induced myocardial injury(SIMI)and to explore its potential therapeutic value.Methods Data for this study were sourced from the medical information mart for intensive care(MIMIC)-Ⅳdatabase.Eligible 2450 SIMI patients were categorized into an ACEI group and a non-ACEI group.Propensity score matching(PSM)was pe rformed to reduce baseline bias,with the primary outcome being 28-day all-cause mortality.The effects of ACEI on SIMI patients′prognosis were assessed by using Kaplan-Meier(K-M)curves,multivariate Cox regression analysis and subgroup analysis.External validation was conducted in 114 SIMI patients from Beijing Chaoyang Hospital,Capital Medical University.Results A total of 2450 and 1042 patients were included in the analysis before and after PSM adjustment,respectively.After PSM,the K-M curve showed that the 28-day mortality rate in the ACEI group was significantly lower than that in the non-ACEI group(P<0.001).Multivariate Cox regression analysis indicated that ACEI use was associated with a significantly lower 28-day mortality rate[hazard ratio(HR)=0.56,95%confidence interval(CI)0.42-0.74,P<0.001].Subgroup analysis showed that therapeutic effect of ACEI was consistent across different age,sex and underlying disease groups(interaction P>0.05).Additionally,there was no significant difference in the impact of different types of ACEI on the 28-day mortality rate(P>0.05).The external validation included 114 SIMI patients.The K-M curve revealed a significant association between ACEI use and a reduction in 28-day cumulative mortality(P=0.0017).Multivariate Cox regression analysis further confirmed the protective effect of ACEI,demonstrating a significant reduction in 28-day mortality(HR=0.22,95%CI 0.05-0.91,P=0.036).Conclusions The use of ACEI is significantly associated with a reduced 28-day all-cause mortality in SIMI patients,supporting its potential therapeutic value.
作者
陈莹
魏述星
王茜雅
王锦龙
董红锰
高珍珍
郭树彬
梅雪
Chen Ying;Wei Shuxing;Wang Xiya;Wang Jinlong;Dong Hongmeng;Gao Zhenzhen;Guo Shubin;Mei Xue(Emergency Medicine Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)
出处
《中国急救医学》
2025年第4期316-322,共7页
Chinese Journal of Critical Care Medicine
基金
北京市卫生健康委员会首都卫生发展科研专项(首发2024-2-2034)。
