感染性休克患者心肌损伤程度与氧化应激水平的相关性分析

Correlation between myocardial injury and oxidative stress in patients with septic shock

目的分析感染性休克患者心肌损伤程度与氧化应激水平的相关性。方法选取2019年4月-2021年6月定州市人民医院收治的60例感染性休克患者作为研究对象,根据是否合并心肌损伤分为心肌损伤组(n=24)和无心肌损伤组(n=36),比较两组患者血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、N末端B型利钠肽前体(NT-proBNP)、肌红蛋白(myoglobin,MYO)、同型半胱氨酸(Hcy)、超氧化物歧化酶(SOD)水平,并分析心肌损伤程度与氧化应激水平的相关性。根据患者住院28 d的生存情况分为生存组和死亡组,统计分析两组患者血清氧化应激水平及其对预后的诊断价值。结果心肌损伤组患者血清cTnI、CK-MB、NT-proBNP、MYO、Hcy水平分别为(2.13±0.52)μg/L、(37.46±5.17)U/L、(3796.15±564.03)ng/L、(73.24±13.52)μg/L、(17.59±2.76)μmol/L,高于无心肌损伤组(0.11±0.04)μg/L、(21.08±3.58)U/L、(2617.63±312.57)ng/L、(39.33±9.29)μg/L、(10.81±2.84)μmol/L;SOD水平为(36.22±5.87)U/L,低于无心肌损伤组(47.13±4.49)U/L,差异均有统计学意义(P均<0.05)。Spearman相关性分析显示,血清cTnI、CK-MB、NT-proBNP、MYO水平均与Hcy成正相关(r=0.418、0.520、0.397、0.420,P均<0.05),与SOD均成负相关(r=-0.617、-0.585、-0.472、-0.550,P均<0.05)。死亡组患者血清Hcy水平高于生存组,SOD水平低于生存组,差异均有统计学意义(P均<0.05)。ROC曲线分析显示,血清Hcy、SOD联合预测感染性休克患者预后的AUC为0.906,高于各指标单一检测(Hcy:0.817,SOD:0.769),差异有统计学意义(Z=2.392、2.405,P均<0.05)。结论感染性休克患者心肌损伤程度与氧化应激水平具有相关性,可用于预后评估。

Objective To analyze the correlation between myocardial injury and oxidative stress in patients with septic shock.Methods A total of 60 patients with septic shock admitted between April 2019 and June 2021 were enrolled as the research objects.According to presence or absence of myocardial injury,they were divided into myocardial injury group(n=24)and non-myocardial injury group(n=36).The serum myocardial injury indexes and oxidative stress indexes between the two groups were compared.Correlations between cardiac troponin I(cTnI),creatine kinase isoenzymes-MB(CK-MB),N-terminal pro-B type natriuretic peptide(NT-proBNP),myoglobin(MYO),homocysteine(Hcy)and superoxide dismutase(SOD)were analyzed.According to 28 d survival conditions after admission,they were divided into survival group and death group.The levels of serum oxidative stress indexes in both groups were statistically analyzed and their diagnostic value for prognosis was analyzed.Results In the myocardial injury group,the serum levels of cTnI,CK-MB,NT-proBNP,MYO and Hcy were(2.13±0.52)μg/L,(37.46±5.17)U/L,(3796.15±564.03)ng/L,(73.24±13.52)μg/L and(17.59±2.76)μmol/L,respectively,and were higher than those in the no myocardial injury group(0.11±0.04)μg/L,(21.08±3.58)U/L,(2617.63±312.57)ng/L,(39.33±9.29)μg/L,(10.81±2.84)μmol/L.The SOD level of the myocardial injury group(36.22±5.87)U/L was lower than that of no myocardial injury group(47.13±4.49)U/L.The differences were all statistically significant(P<0.05).Spearman correlation analysis showed that levels of serum cTnI,CK-MB,NT-proBNP and MYO were positively correlated with Hcy(r=0.418,0.520,0.397,0.420,all P<0.05),while negatively correlated with SOD(r=-0.617,-0.585,-0.472,-0.550,all P<0.05).The level of serum Hcy in death group was higher than that in survival group,while SOD level was lower than that in survival group(P<0.05).The results of ROC curves analysis showed that AUC of Hcy combined with SOD for predicting prognosis of septic shock was 0.906,greater than that of Hcy(0.817)and SOD(0.769)alone(Z=2.392,2.405,all P<0.05).Conclusion The severity of myocardial injury was correlated with oxidative stress level in patients with septic shock,which could be applied in prognosis evaluation.