脓毒症患者心肌损伤早期血清FABP3和GPBB表达水平及其临床意义研究

Expression of serum FABP3and GPBB in children with sepsis-induced myocardial injury and its clinical significance

目的:探讨血清心脏型脂肪酸结合蛋白(fatty acid binding protein 3,FABP3)与糖原磷酸化酶同工酶脑型(glycogen phosphorylase isoenzyme BB,GPBB)在脓毒症患者心肌损伤中的表达水平及其临床意义。方法:对诊断为脓毒症的102例患者根据心肌损伤诊断标准分为非心肌损伤组(71例)和心肌损伤组(31例),并选取同期我院就诊非脓毒症感染患者24例为对照组。分别在脓毒症确诊后1h、6h和24h比较3组患者血清FABP3、GPBB、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和肌酸激酶(CK)的表达水平。应用Pearson相关分析法分析FABP3、GPBB与cTnI在不同时间点的相关性。绘制受试者工作特征曲线(ROC),评价血清FABP3、GPBB和cTnI对心肌损伤的诊断价值。结果:脓毒症患者心肌损伤发生率为31.39%(31/102)。心肌损伤组患者LVEF值明显低于非心肌损伤组,差异具有统计学意义(P<0.05)。1h时心肌损伤组患者血清FABP3、GPBB和CK-MB表达水平明显高于非心肌损伤组和对照组,差异具有统计学意义(P<0.05)。6h和24h时心肌损伤组患者血清FABP3、GPBB、cTnI、CK和CK-MB表达水平均明显高于非心肌损伤组和对照组,差异具有统计学意义(P<0.05)。1h时FABP3、GPBB与cTnI无相关性(r分别为0.206,0.234,P>0.05)。6h时FABP3、GPBB与cTnI呈正相关性(r分别为0.505,0.419,P<0.05)。24h时FABP3、GPBB与cTnI呈正相关性(r分别为0.615,0.579,P<0.05)。6h和24h时FABP3、GPBB与cTnI 3项联合诊断心肌损伤的曲线下面积(AUC)分别为0.912和0964,其敏感度和特异度分别为90.33%、86.31%与96.25%、89.17%。6h时FABP3诊断心肌损伤的AUC(0.855)明显高于cTnI(0.773)(Z=4.032,P<0.05),而GPBB与cTnI比较差异无统计学意义(Z=1.536,P>0.05)。24h时FABP3和GPBB诊断心肌损伤的AUC(0.886、0.867)明显低于cTnI(0.912),差异具有统计学意义(P>0.05)。结论:血清FABP3、GPBB可以与cTnI联合作为早期诊断脓毒症患者心肌损伤的有效生物学标志物。

Objective:To explore the expression of serum fatty acid binding protein 3(FABP3)and glycogen phosphorylase isoenzyme BB(GPBB)in children with sepsis-induced myocardial injury and its clinical significance.Methods:A total of 102children with sepsis were enrolled.According to the presence or absence of myocardial injury,these children were divided into non-myocardial injury group(n=71)and myocardial injury group(n=31).24healthy children were recruited in control group.Serum levels of FABP3,GPBB,cTnI,CK-MB and CK were compared at 1h,6hand 24hafter diagnosis of sepsis.Pearson correlation analysis was used to determine the correlation of FABP3and GPBB with cTnI.The receiver operating characteristic(ROC)curve was plotted to evaluate the value of serum FABP3,GPBB and cTnI in the diagnosis of myocardial injury.Results:The incidence of myocardial injury in children with sepsis was 31.39%(31/102).The LVEF value of the children with myocardial injury was significantly lower than that of the non-myocardial injury group(P<0.05).The expression levels of serum FABP3,GPBB and CK-MB in the myocardial injury group were significantly higher than those in the non-myocardial injury group and the control group at 1h(P<0.05).The levels of serum FABP3,GPBB,cTnI,CK and CKMB in the myocardial injury group were significantly higher than those in the non-myocardial injury group and the control group at 6hand 24h(P<0.05).There was no correlation between FABP3,GPBB and cTnI at 1h(r=0.206,0.234,P>0.05).At 6h,FABP3,GPBB and cTnI were positively correlated(r=00.55,0.419,P<0.05).At 24h,FABP3and GPBB were positively correlated with cTnI(r=0.615,0.579,P<0.05).At 6hand 24h,the area under the curve(AUC)of FABP3,GPBB and cTnI combined diagnosis of myocardial injury was 0.912and 0964,respectively.The sensitivity and specificity were 90.33%,86.31%,96.25%and 89.17%,respectively.The AUC(0.855)of myocardial injury with FABP3was significantly higher than that of cTnI(0.773)at 6h(Z=4.032,P<0.05),but there was no significant difference between GPBB and cTnI(Z=1.536,P>0.05).The AUC(0.886,0.867)of myocardial injury induced by FABP3and GPBB at 24hwas significantly lower than that of cTnI(0.912),and the difference was statistically significant(P>0.05).Conclusion:Serum FABP3 and GPBB can be combined with cTnI as an effective biomarker for early diagnosis of myocardial injury in children with sepsis.