血清心肌素、和肽素水平与脓毒症心肌损伤密切相关

Correlations between the levels of serum myocardin, copeptin and myocardial injury in sepsis

目的:研究血清心肌素、和肽素水平与脓毒症心肌损伤的相关性。方法:选取76例脓毒症患者,根据有无心肌损伤分为心肌损伤组(35例)与非心肌损伤组(41例)。另外选取80例健康体检者为对照组。比较3组血清心肌素、和肽素及常见心肌标志物肌钙蛋白Ⅰ(cTnI)、B型尿钠肽(BNP)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平;采用Pearson分析心肌素、和肽素与左心室射血分数(LVEF)的相关性;采用多因素Logistic回归模型分析脓毒症患者并发心肌损伤的影响因素;绘制受试者工作特征曲线(ROC)评估心肌素、和肽素水平对脓毒症患者并发心肌损伤的诊断价值。结果:与对照组比较,心肌损伤组和非心肌损伤组cTnI、BNP、CK、CK-MB、和肽素水平均较高(P均<0.05),且心肌损伤组高于非心肌损伤组(P均<0.05)。心肌损伤组心肌素水平较对照组和非心肌损伤组低(P均<0.05);Pearson相关分析显示,心肌损伤组血清心肌素水平与LVEF呈正相关(P<0.05);和肽素与LVEF呈负相关(P <0.05)。多因素Logistic回归分析显示,cTnI、BNP、CK、CK-MB、和肽素均是脓毒症患者合并心肌损伤的危险因素,心肌素是保护因素;血清心肌素、和肽素单独及两者联合诊断脓毒症患者并发心肌损伤的曲线下面积分别为0.796、0.868、0.913,心肌素单独诊断的截断值为101.98 ng/L,敏感度为71.40%,特异性为73.20%,和肽素单独诊断的截断值为22.58μg/L,敏感度为68.60%,特异性为92.70%,两者联合诊断的敏感度为74.30%,特异性为95.10%。结论:血清心肌素、和肽素水平与脓毒症患者并发心肌损伤密切相关,具有一定诊断价值,可能成为临床评估脓毒症患者心肌损伤的生物标志物。

Objective:To study the correlations between the levels of serum myocardin,copeptin and myocardial injury in sepsis.Methods:A study was conducted on 76 patients with sepsis.According to whether there was myocardial injury or not,the patients were divided into myocardial injury group(35 cases) and non-myocardial injury group(41 cases).In addition,80 healthy people were selected as the control group.The differences in serum myocardin,copeptin,and common cardiac markers cardiac troponin I(cTnI),B-type natriuretic peptide(BNP),creatine kinase(CK),creatine kinase isoenzyme(CK-MB) levels were compared among the three groups.The Pearson was used to analyze the correlations between myocardin,copeptin and left ventricular ejection fraction(LVEF).The multivariate logistic regression model was used to analyze the influencing factors of myocardial injury in sepsis patients.The receiver operating characteristic(ROC) curve was drawn to evaluate the diagnostic value of cardioxin and copeptin in patients with sepsis complicated with myocardial injury.Results:Compared with the control group,the levels of cTnI,BNP,CK,CK-MB and copeptin were significantly increased in non-myocardial injury group(P <0.05).There was no significant difference in the level of myocardin(P>0.05),the levels of cTnI,BNP,CK,CK-MB,myocardin and copeptin were higher in myocardial injury group(P <0.05);the above indexes in myocardial injury group were significantly higher than those in non-myocardial injury group(P <0.05).The Pearson correlation analysis showed that there was a positive correlation between serum myocardin and LVEF(P <0.05);there was a negative correlation between copeptin and LVEF(P <0.05).The results of multivariate logistic regression analysis showed that cTnI,BNP,CK,CK-MB,and copeptin were risk factors of sepsis with myocardial injury,and myocardin was a protective factor.The area under the curve(AUC) of serum myocardin,copeptin alone or combined with them in the diagnosis of sepsis complicated with myocardial injury was 0.796,0.868 and 0.913,respectively.The cut-off value of myocardin alone was 101.98 ng/L,the sensitivity and specificity were 71.40% and 73.20%,respectively,and the cutoff value of copeptin alone was 22.58 μg/L,the sensitivity and specificity were 68.60% and 92.70% respectively.The sensitivity and specificity of combined diagnosis were 74.30% and 95.10% respectively.Conclusions:Serum myocardin and copeptin are closely related to myocardial injury in sepsis,which have certain diagnostic value and may be biomarkers for clinical evaluation of myocardial injury in sepsis patients.