摘要
目的探究脓毒症并发心肌病患者血清α-羟基丁酸脱氢酶(α-HBDH)、富含半胱氨酸蛋白61(CYR61)和焦孔素D(GSDMD)水平检测对临床诊断及预后评估的价值。方法选取2020年5月~2023年12月于包头市中心医院进行诊治的244例脓毒症患者作为研究对象,根据其是否并发心肌病分为研究组(并发心肌病,n=106)和对照组(未并发心肌病,n=138)。酶联免疫吸附试验(ELISA)检测血清α-HBDH,CYR61和GSDMD水平;采用Pearson和Spearman法分析α-HBDH,CYR61,GSDMD与收缩压、舒张压、左心室射血分数(LVEF)以及急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)的相关性;通过多因素Logistic回归分析影响脓毒症并发心肌病的因素。受试者工作特征(ROC)曲线用于评估α-HBDH,CYR61和GSDMD对脓毒症并发心肌病的诊断价值以及预后预测的有效性。结果与对照组比较,研究组血清α-HBDH(278.35±18.89ng/ml vs 253.47±12.75ng/ml),CYR61(18.23±4.14mg/L vs 14.48±2.67mg/L),GSDMD(12.39±3.28mg/L vs 9.46±2.17mg/L)水平升高,差异具有统计学意义(t=12.261,8.572,8.377,均P<0.05);死亡组患者α-HBDH(291.93±19.22ng/ml),CYR61(20.33±3.43mg/L),GSDMD(14.01±3.09mg/L)水平较生存组(268.71±13.09ng/ml,16.74±2.88mg/L,11.24±2.55mg/L)患者更高,差异具有统计学意义(t=7.402,5.839,5.044,均P<0.05)。相关性分析显示,α-HBDH,CYR61,GSDMD与收缩压、舒张压,LVEF呈负相关(r=-0.631~-0.422,均P<0.05);α-HBDH,CYR61,GSDMD与APACHEⅡ评分呈正相关(r=0.531,0.507,0.611,均P<0.05)。多因素Logistic回归分析得知收缩压、舒张压、LVEF是影响脓毒症并发心肌病的保护因素(Waldχ^(2)=6.823,7.986,10.875,均P<0.05);α-HBDH,CYR61,GSDMD是影响脓毒症并发心肌病的危险因素(Waldχ^(2)=9.376,6.849,7.435,均P<0.05)。经ROC曲线分析,α-HBDH,CYR61和GSDMD联合检测对脓毒症并发心肌病的诊断效果优于各项单独检测(Z=2.369,2.454,2.573);对脓毒症并发心肌病进行预后预测的效果更优(Z=2.352,2.468,2.581),差异具有统计学意义(均P<0.05)。结论脓毒症并发心肌病患者血清α-HBDH,CYR61,GSDMD水平上升,且与预后相关。三者联合检测对脓毒症并发心肌病的诊断以及预后预测价值更高。
Objective To investigate the value of serumα-hydroxybutyric dehydrogenase(α-HBDH),cysteine-rich protein 61(CYR61)and gasdermin D(GSDMD)level testing in patients with sepsis-combined cardiomyopathy for clinical diagnosis and prognostic assessment.Methods A total of 244 sepsis patients who underwent consultation and treatment in Baotou Central Hospital from May 2020 to December 2023 were selected as the study subjects,and were separated into a study group(combined cardiomyopathy,n=106)and a control group(uncombined cardiomyopathy,n=138)according to whether they were combined cardiomyopathy or not.The levels ofα-HBDH,CYR61 and GSDMD were measured by enzyme linked immunosorbent assay(ELISA)method.Pearson and Spearman methods were used to analyze the correlation ofα-HBDH,CYR61,and GSDMD with systolic and diastolic blood pressure,left ventricular ejection fraction(LVEF)and acute physiology and chronic health evaluationⅡ(APACHE II)score.Multifactorial Logistic regression was used to analyze the factors affecting sepsis-combined cardiomyopathy.Receiver operator characteristic(ROC)curves were used to assess the diagnostic value ofα-HBDH,CYR61 and GSDMD for sepsis-combined cardiomyopathy and their validity for prognostic prediction.Results Serumα-HBDH(278.35±18.89ng/ml vs 253.47±12.75ng/ml),CYR61(18.23±4.14mg/L vs 14.48±2.67mg/L)and GSDMD(12.39±3.28mg/L vs 9.46±2.17mg/L)levels were higher in the study group compared to the control group,and the differences were statistically significant(t=12.261,8.572,8.377,all P<0.05).The levels ofα-HBDH(291.93±19.22ng/ml),CYR61(20.33±3.43mg/L)and GSDMD(14.01±3.09mg/L)were higher in the death patients compared to the survived patients(268.71±13.09ng/ml,16.74±2.88mg/L,11.24±2.55mg/L),and the differences were statistically significant(t=7.402,5.839,5.044,all P<0.05).Correlation analysis showed thatα-HBDH,CYR61,and GSDMD were negatively correlated with systolic blood pressure,diastolic blood pressure and LVEF(r=-0.631~-0.422,all P<0.05),α-HBDH,CYR61,GSDMD were negatively correlated with APACHE II score(r=0.531,0.507,0.611,all P<0.05).Multifactorial Logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,and LVEF were protective factors affecting sepsis-combined cardiomyopathy(Waldχ^(2)=6.823,7.986,10.875,all P<0.05),andα-HBDH,CYR61,and GSDMD were risk factors affecting sepsis-combined cardiomyopathy(Waldχ^(2)=9.376,6.849,7.435,all P<0.05).From the ROC curve analysis,it was known that the combined application ofα-HBDH,CYR61,and GSDMD was more effective in the diagnosis of sepsis-combined cardiomyopathy(Z=2.369,2.454,2.573),the combined application ofα-HBDH,CYR61,and GSDMD were superior for prognostic prediction in sepsis-combined cardiomyopathy(Z=2.352,2.468,2.581),and the differences were statistically significant(all P<0.05).Conclusion Serumα-HBDH,CYR61 and GSDMD levels are increased in patients with sepsis-combined cardiomyopathy,and they are correlated with prognosis.The combination of these three tests has a higher diagnostic value and prognostic value in sepsis combined cardiomyopathy.
作者
贺丹娜
赵瑞平
杨扬
李帷
王义华
闫涛
宋秀荣
HE Danna;ZHAO Ruiping;YANG Yang;LI Wei;WANG Yihua;YAN Tao;SONG Xiurong(Department of Cardiovascular Medicine,Baotou Institute of Cardiovascular Disease,Inner Mongolia Baotou 0140401,China;ICU,Baotou Central Hospital,Inner Mongolia Baotou 0140401,China)
出处
《现代检验医学杂志》
2025年第5期119-123,共5页
Journal of Modern Laboratory Medicine
基金
内蒙古自治区自然科学基金项目(2021MS08120)
国家自然科学基金委员会计划项目(81760077)。
