摘要
目的探讨七氟烷通过自噬-溶酶体途径对围术期老年心肌缺血再灌注损伤(MIRI)患者心肌保护效应的机制,并评估血清Cathepsin B活性与LC3-Ⅱ/Ⅰ比值联合检测在心功能恢复预测中的临床应用价值。方法用前瞻性随机对照设计,纳入2023年1月至2024年12月新疆医科大学第六附属医院收治的128例接受髋或膝关节置换术的老年MIRI高风险患者,随机分为实验组(七氟烷后处理,n=64)与对照组(常规麻醉,n=64)。术后6月随访左室射血分数(LVEF)变化及主要不良心血管事件(MACE)分为预后良好组与不良组,形成4个分层亚组。检测手术前后心功能指标、炎症/氧化应激指标,并测定血清组织蛋白酶B(Cathepsin B)活性与轻链3比值(LC3-Ⅱ/Ⅰ)。采用工作特征曲线(ROC)及多因素Logistic回归分析预测效能及独立风险因素。结果4组间术后Cathepsin B活性与LC3-Ⅱ/Ⅰ比值存在显著差异,实验组预后良好组2项指标最低,对照组预后不良组最高。LVEF变化(ΔLVEF)在实验组预后良好组显著高于其他组(P<0.001)。ROC分析结果显示,Cathepsin B活性AUC为0.87(95%CⅠ:0.83~0.91),LC3-Ⅱ/Ⅰ比值AUC为0.81(95%CⅠ:0.76~0.86),联合检测AUC提升至0.92(95%CⅠ:0.88~0.96)。Logistic回归分析证实两者为心功能恢复的独立预测因素。结论七氟烷通过激活自噬-溶酶体通路,发挥心肌保护作用。血清Cathepsin B活性与LC3-Ⅱ/Ⅰ比值联合检测可有效预测围术期心肌功能,具有重要临床应用价值。
Objective To explore the cardioprotective mechanism of sevoflurane via the autophagy-lysosome path-way in perioperative elderly patients with myocardial ischemia-reperfusion injury(MIRI),and to evaluate the clinical predictive value of combined serum Cathepsin B activity and LC3-Ⅱ/Ⅰ ratio for cardiac function recovery.Methods sIna prospective randomized controlled trial,128 elderly high-risk MIRI patients undergoing elective hip or knee arthroplasty at Xinjiang Medical University Affiliated Hospital from January 2023 to December 2024 were enrolled.Patients were randomized into the experimental group(sevoflurane postconditioning,n=64)and control group(routine anesthesia,n=64).Patients were stratified into favorable and unfavorable prognosis groups according to postoperative changes in LVEF over a 6-month follow-up period and the incidence of major adverse cardiac events(MACE),thereby generating four prognostic subgroups for comparative analysis.Cardiac function parameters(LVEF,troponin[cTnI],creatine ki-nase isoenzyme MB[CK-MB]),inflammatory and oxidative stress markers(C-reactive protein[CRP],Malondialdehyde[MDA]),and serum Cathepsin B activity and LC3-Ⅱ/Ⅰratio were assessed.Receiver operating characteristic(ROC)curve and multivariate logistic regression analyses were performed.Results Significant differences in postoperative ser-um Cathepsin B activity and LC3-Ⅱ/Ⅰ ratio were observed among the four subgroups,with the lowest levels detected in the sevoflurane-treated favorable prognosis group and the highest levels in the control unfavorable prognosis group.Postoperative△LVEF was significantly greater in the sevoflurane-treated favorable group compared to all other sub-groups(P<0.001).ROC analysis demonstrated that Cathepsin B activity had an AUC of 0.87(95%CI:0.83~0.91),LC3-Ⅱ/Ⅰ ratio had an AUC of 0.81(95%CI:0.76~0.86),and the combined detection achieved an AUC of 0.92(95%CI:0.88~0.96).Logistic regression confirmed both markers as independent predictors of cardiac function recovery.Conclusion Sevoflurane exerts cardioprotective effects through the activation of the autophagy-lysosome pathway.Combined detection of serum Cathepsin B activity and LC3-Ⅱ/Ⅰratio offers a valuable tool for predicting cardiac func-tion recovery in perioperative elderly MIRI patients.
作者
刘刚
王伟
宋峰
LIU Gang;WANG Wei;SONG Feng(Department of Anesthesiology,The Sixth Affiliated Hospilal of Xinjiang Medical Universily,Urumqi 830002,China)
出处
《中国实验诊断学》
2025年第8期916-921,共6页
Chinese Journal of Laboratory Diagnosis
基金
新疆围术期器官保护重点实验室自主开放课题重点项目(XJDX1411-2025-MZZ2)。
