血清PCT、NT-proBNP、mtDNA水平与CPB心脏术后早期并发症的关系及其预测价值研究

The relationship between serum PCT,NT-proBNP,mtDNA levels and early complications after cardiac surgery involving CPB and their predictive value

目的分析体外循环(cardiopulmonary bypass,CPB)心脏手术患者血清降钙素原(procalcitonin,PCT)、N端脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)、线粒体DNA(mitochondrial DNA,mtDNA)水平变化,并分析其预测早期并发症的价值。方法选取CPB心脏术患者108例为观察组,另选取同期健康体检者108例为对照组,采用酶联免疫法检测血清PCT、NT-proBNP、mtDNA水平并进行比较,统计术后早期并发症发生情况并比较是否发生并发症患者的一般资料,采用Logistic回归分析术后发生早期并发症的影响因素,采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析血清PCT、NT-proBNP、mtDNA对预测早期并发症的价值,并通过相加模型评价三者之间的交互作用。结果CPB心脏术患者血清PCT、NT-proBNP、mtDNA水平高于健康体检者(P<0.05);108例患者并发症发生率为37.96%;发生早期并发症的CPB心脏术患者与未发生并发症患者的在急诊手术、术前心功能分级、手术时间、体外循环时间、主动脉阻断时间、血清PCT、NT-proBNP、mtDNA水平等方面比较均差异有统计学意义(P<0.05);血清PCT、NT-proBNP、mtDNA水平是CPB心脏术患者发生早期并发症的影响因素(P<0.05);ROC显示,PCT、NT-proBNP、mtDNA联合预测CPB心脏术后早期并发症的AUC值最大0.832,对应敏感度为77.61%,特异度为82.98%;血清PCT、NT-proBNP、mtDNA对患者发生早期并发症存在协同作用。结论CPB心脏术后患者血清PCT、NT-proBNP、mtDNA呈高水平表达,三者高水平表达均为术后发送早期并发症的独立危险因素,且三者之间存在协同作用,对预测早期并发症发生具有较高价值,对指导临床及早采取干预措施有积极作用。

Objective To analyze the changes of serum procalcitonin(PCT),N-terminal natriuretic peptide precursor(NT-proBNP)and mitochondrial DNA(mtDNA)levels in patients undergoing cardiopulmonary bypass(CPB)and to explore its value in predicting early complications.Methods A total of 108 patients undergoing cardiac surgery involving CPB were selected as the observation group,and 108 healthy people undergoing physical examination during the same period were selected as the control group.The levels of serum PCT,NT-proBNP and mtDNA were measured by enzyme-linked immunosorbent assay(ELISA)and compared.The incidence of early complications after surgery was calculated and the general data of patients with or without complications were compared.The factors affecting early complications after surgery were analyzed by logistic regression analysis.The value of serum PCT,NT-proBNP and mtDNA in predicting early complications was analyzed by receiver operating characteristic(ROC)curve,and the interaction among the three was evaluated by additive model.Results The serum levels of PCT,NT-proBNP and mtDNA in patients undergoing cardiac surgery involving CPB were higher than those in healthy people(P<0.05),and the complication rate of 108 patients was 37.96%.There were significant differences in emergency surgery,preoperative cardiac function classification,duration of operation,duration of cardiopulmonary bypass,duration of aortic block,serum PCT,NT-proBNP,and mtDNA levels between patients undergoing cardiac surgery involving CPB with early complications and those without early complications(P<0.05).The levels of serum PCT,NT-proBNP and mtDNA were the influencing factors of early complications in patients undergoing cardiac surgery involving CPB(P<0.05).ROC curve showed that area under the ROC curve(AUC)of PCT,NT-proBNP and mtDNA in combination to predict early complications in patients undergoing cardiac surgery involving CPB was the largest,the corresponding sensitivity was 77.61%,and the specificity was 82.98%.Serum PCT,NT-proBNP and mtDNA had a synergistic effect on the occurrence of early complications in patients.Conclusion Serum PCT,NT-proBNP,and mtDNA are highly expressed in patients undergoing cardiac surgery involving CPB.The high levels of the three are independent risk factors for early postoperative complications,and there is a synergistic effect among them,which is of high value in predicting early complications.In addition,it has a positive effect on guiding clinical intervention measures as soon as possible.