铁死亡相关蛋白GPX4在脓毒症心肌损伤中表达与血管内皮损伤的关系

Expression of iron-death related protein GPX4 with myocardial injury in sepsis and its relationship with vascular endothelial injury

目的观察谷胱甘肽过氧化物酶4在脓毒症心肌损伤患者中的表达,分析其与血管内皮损伤的相关性及对脓毒症患者的诊断价值。方法收集2021年4月至2024年2月本院146例脓毒症患者的临床资料,根据左心室射血分数(LVEF)将患者分为心肌损伤组(n=77)和非损伤组(n=69)。测量LVEF,检测血清谷胱甘肽过氧化物酶4(GPX4)、B型脑钠肽(BNP)、肌酸激酶同工酶MB(CK-MB)、肌钙蛋白I(cTnI)、血管假性血友病因子(vWF)、内皮素-1(ET-1)和一氧化氮(NO)水平。分析GPX4水平与血管内皮损伤因子的相关性及GPX4对脓毒症心肌损伤的评估效能。结果与非损伤组比较,心肌损伤组患者血清BNP、CK-MB、cTnI显著升高(P<0.05),GPX4显著下降(P<0.05);血管内皮损伤因子vWF、ET-1升高,NO下降(P<0.05)。相关性分析显示,谷胱甘肽过氧化物酶4水平与NO表达呈正相关(r=0.87,P<0.001),与vWF、ET-1呈负相关(r=-0.80,P<0.001;r=-0.81,P<0.001)。ROC曲线分析显示,GPX4对心肌损伤的预警价值较高[曲线下面积(AUC)为0.83,P<0.001],最佳截断值为0.5598(灵敏度为92.21%,特异度为63.77%)。结论GPX4水平的降低可能反映了心肌和血管内皮的损伤状态,具有较高的预警价值。因此,谷胱甘肽过氧化物酶4可作为评估脓毒症心肌损伤发生的潜在指标,为临床诊断和治疗提供新的思路。

Objective To observe the expression of ferroptosis-related protein GPX4 in patients with myocardial injury caused by sepsis,analyze its correlation with vascular endothelial injury,and assess its diagnostic value for sepsis.Methods Clinical data of 146 sepsis patients admitted to our hospital from April 2021 to May 2024 were collected.According to left ventricular ejection fraction(LVEF),patients were divided into myocardial injury group(n=77)and non-injury group(n=69).LVEF was measured,and serum levels of glutathione peroxidase 4(GPX4),B-type natriuretic peptide(BNP),creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),von Willebrand factor(vWF),endothelin-1(ET-1),and nitric oxide(NO)were tested.The correlation between GPX4 levels and vascular endothelial injury factors,and the diagnostic efficacy of GPX4 for myocardial injury in sepsis were analyzed.Results Compared to the non-injury group,the myocardial injury group had significantly higher levels of BNP,CK-MB,and cTnI(P<0.05)and significantly lower GPX4 levels(P<0.05).Endothelial injury factors vWF and ET-1 were elevated,while NO levels were reduced(P<0.05).Correlation analysis showed that GPX4 levels were positively correlated with NO expression(r=0.87,P<0.001)and negatively correlated with vWF and ET-1 levels(r=-0.80,P<0.001;r=-0.81,P<0.001).ROC curve analysis indicated that GPX4 has a high predictive value for myocardial injury[area under the curve(AUC)=0.83,P<0.001],with an optimal cutoff value of 0.5598(sensitivity=92.21%,specificity=63.77%).Conclusions Ferroptosis-related protein GPX4 is lowly expressed in the serum of sepsis patients with myocardial injury,and its level is closely related to vascular endothelial function.GPX4 could serve as a potential marker for evaluating myocardial injury in sepsis patients.