血浆MT-ND1基因对脓毒症心肌病的诊断价值

Value of plasma MT-ND1 to the diagnosis of septic cardiomyopathy

目的观察脓毒症心肌病患者血浆MT-ND1基因表达变化,探讨其对脓毒症心肌病的诊断价值。方法脓毒症患者59例,入院次日行超声心动图检查,25例并发心肌病者为并发心肌病组,34例未并发心肌病者为未并发心肌病组。2组入院次日采集空腹静脉血,分离提取血浆线粒体DNA,采用实时荧光定量PCR法检测MT-ND1相对表达量。比较2组入院次日血清C反应蛋白、降钙素原、干扰素-γ、血肌酐、肌酸激脢、乳酸盐脱氢酶、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、肌钙蛋白I水平及序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、急性生理与慢性健康Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、左室射血分数等指标;多因素logistic回归分析脓毒症患者发生脓毒症心肌病的影响因素;绘制ROC曲线,评估脓毒症患者血清NT-proBNP及血浆MT-ND1相对表达量对脓毒症心肌病的诊断效能。结果并发心肌病组血清降钙素原[16.0(6.2,71.5)ng/L]、NT-proBNP[7505(2911,24540)ng/L]、肌钙蛋白I[0.07(0.02,0.20)μg/L]水平及MT-ND1相对表达量[52.7(23.8,297.4)]均高于未并发心肌病组[8.0(1.8,17.9)ng/L、1422(393,4534)ng/L、0.01(0.01,0.07)μg/L、12.5(4.8,52.3)](P<0.05),有手术史比率(36.0%)、SOFA评分[6.0(3.0,8.0)分]均低于未并发心肌病组[64.7%、6.5(4.0,9.0)分](P<0.05),男性比率、年龄、APACHEⅡ评分、白细胞计数、血小板计数及血清C反应蛋白、肿瘤坏死因子-α、干扰素-γ、血乳酸、白蛋白、谷丙转氨酶、谷草转氨酶、血肌酐、肌酸激酶、乳酸脱氢酶、肌红蛋白水平与未并发心肌病组比较差异均无统计学意义(P>0.05)。血清NT-proBNP(OR=1.015,95%CI:1.00~1.03,P=0.008)及血浆MT-ND1(OR=1.010,95%CI:1.00~1.02,P=0.013)是脓毒症患者发生脓毒症心肌病的影响因素。NT-proBNP、MT-ND1分别以1939 ng/L、27.03为最佳截断值,单独及联合检测诊断脓毒症心肌病的AUC分别为0.799(95%CI:0.689~0.909,P<0.001)、0.764(95%CI:0.644~0.883,P<0.001)、0.865(95%CI:0.772~0.958,P<0.001),灵敏度分别为92%、76%、72%,特异度分别为58.8%、61.8%、94.1%。结论脓毒症心肌病患者MT-ND1表达上调,联合检测NT-proBNP可提高脓毒症心肌病的诊断效能。

Objective To observe the changes of plasma MT-ND1 gene in patients with septic cardiomyopathy,and to investigate its diagnostic value for septic cardiomyopathy.Methods Fifty-nine patients with sepsis received echocardiography the next day after admission,in which 25 patients were complicated with cardiomyopathy(cardiomyopathy group)and 34 patients were not complicated with cardiomyopathy(no-cardiomyopathy group).The fasting venous blood was collected from two groups the next day after admission,and plasma mitochondrial DNA was isolated and extracted.The relative expression of plasma MT-ND1 was detected by real-time fluorescence quantitative PCR.The levels of serum C-reactive protein,procalcitonin,interferon-γ,creatinine,creatine kinase,lactate dehydrogenase,N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin I,sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,left ventricular ejection fraction and other clinical data were compared between two groups the next day after admission.Multivariate logistic regression was done to analyze the influencing factors of septic cardiomyopathy.The ROC curves were drawn to evaluate the diagnostic efficiencies of serum NT-proBNP and plasma MT-ND1 on the diagnosis of septic cardiomyopathy.Results The serum levels of procalcitonin,NT-proBNP and troponin I as well as the relative expression of MT-ND1 were higher in cardiomyopathy group[16.0(6.2,71.5)ng/L,7505(2911,24540)ng/L,0.07(0.02,0.20)μg/L,52.7(23.8,297.4)]than those in no-cardiomyopathy group[8.0(1.8,17.9)ng/L,1422(393,4534)ng/L,0.01(0.01,0.07)μg/L,12.5(4.8,52.3)](P<0.05),the percentage of patients with operation history and SOFA score were lower in cardiomyopathy group[36.0%,6.0(3.0,8.0)]than those in no-cardiomyopathy group[64.7%,6.5(4.0,9.0)](P<0.05),and there were no significant differences in the male ratio,age,APACHEⅡscore,white blood cell count,platelet count,C-reactive protein,tumor necrosis factor-α,interferon-γ,blood lactic acid,albumin,glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase,creatinine,creatine kinase,lactate dehydrogenase and myoglobin between two groups(P>0.05).The serum NT-proBNP(OR=1.015,95%CI:1.00-1.03,P=0.008)and relative expression of plasma MT-ND1(OR=1.010,95%CI:1.00-1.02,P=0.013)were the influencing factors of septic cardiomyopathy in septic patients.When the optimal cut-offvalues of NT-proBNP and MT-ND1were 1939ng/L and 27.03,the AUCs of single and combined detection for the diagnosis of septic cardiomyopathy were 0.799(95%CI:0.689-0.909,P<0.001),0.764(95%CI:0.644-0.883,P<0.001),and 0.865(95%CI:0.772-0.958,P<0.001),the sensitivities were 92%,76%and 72%,and the specificities were 58.8%,61.8%and 94.1%,respectively.Conclusion The relative expression of plasma MT-ND1increases in patients with septic cardiomyopathy,and the combined detection of plasma MT-ND1 and serum NT-proBNP can improve the diagnostic efficiency on septic cardiomyopathy.