血清PCT、CRP、GPBB、HMGB1与脓毒症患儿心肌损伤指标的相关性及与预后的关系

Correlation of Serum PCT,CRP,GPBB and HMGB1 and Myocardial Injury Indexes and Their Relationship with Prognosis in Children with Sepsis

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)、糖原磷酸化酶脑型(GPBB)、高迁移率族蛋白B1(HMGB1)水平与脓毒症患儿心肌损伤指标以及预后的关系。方法:选择2019年3月至2022年3月中国人民解放军联勤保障部队第九二六医院收治的271例脓毒症心肌损伤患儿(心肌损伤组)和同期收治的227例脓毒症感染性疾病但未发生心肌损伤患儿(对照组)。检测两组血清PCT、CRP、GPBB、HMGB1水平以及心肌损伤指标水平。应用Pearson相关系数分析血清PCT、CRP、GPBB、HMGB1与心肌损伤指标之间的相关性。根据心肌损伤组患儿28d的预后情况分为死亡组和存活组,脓毒症心肌损伤患儿死亡的危险因素通过多因素Logistic回归分析。结果:心肌损伤组血清PCT、肌红蛋白(Mb)、CRP、GPBB、心肌肌钙蛋白I(cTnI)、HMGB1、肌酸激酶同工酶(CK-MB)水平均高于对照组(P<0.05)。血清PCT、CRP、GPBB、HMGB1水平均与血清Mb、CK-MB、cTnI水平呈正相关(P<0.05)。死亡组脓毒症休克比例、APACHEⅡ评分、SOFA评分、尿素氮、血肌酐、血清PCT、CRP、GPBB、HMGB1水平高于存活组(P<0.05)。前白蛋白低于存活组(P<0.05)。多因素Logistic回归分析结果显示,高APACHEⅡ评分、存在脓毒症休克、高PCT、高CRP、高GPBB、高HMGB1、高cTnI是脓毒症患儿预后的危险因素(P<0.05)。结论:脓毒症心肌损伤患儿血清PCT、CRP、GPBB、HMGB1水平增高,且与预后不良以及心肌损伤指标有关。

Objective:To investigate the relationship between serum levels of procalcitonin(PCT),C-reactive protein(CRP),glycogen phosphorylase isoenzyme BB(GPBB)and high mobility group protein B1(HMGB1)and myocardial injury indexes and prognosis in children with sepsis.Methods:271 children with sepsis myocardial injury(myocardial injury group)who were admitted to No.926 Hospital of Joint Logistics Support Force of PLA from March 2019 to March 2022 and 227 children with sepsis infectious diseases and without myocardial injury(control group)who were admitted during the same period were selected.The levels of serum PCT,CRP,GPBB,HMGB1 and myocardial injury indexes were detected in both groups.Pearson correlation coefficient was used to analyze the correlation between serum PCT,CRP,GPBB,HMGB1 and myocardial injury indexes.According to the prognosis of children with myocardial injury at 28d,the children in the myocardial injury group were divided into the death group and the survival group,and the risk factors of death in children with myocardial injury of sepsis were analyzed by multivariate Logistic regression.Results:The levels of serum PCT,myoglobin(Mb),CRP,GPBB,cardiac troponin I(cTnI),HMGB1,and creatine kinase isoenzyme(CK-MB)in the myocardial injury group were higher than those in the control group(P<0.05).The levels of serum PCT,CRP,GPBB and HMGB1 were positively correlated with MB,CK-MB and cTnI(P<0.05).The proportion of septic shock,APACHE II score,SOFA score,urea nitrogen,serum creatinine and the levels of serum PCT,CRP,GPBB and HMGB1 in the death group were higher than those in the survival group(P<0.05).The prealbumin was lower than that of survival group(P<0.05).Multivariate Logistic regression analysis showed that high APACHEⅡscore,presence of septic shock,high PCT,high CRP,high GPBB,high HMGB1 and high cTnI were risk factors for prognosis of children with sepsis(P<0.05).Conclusion:The levels of serum PCT,CRP,GPBB and HMGB1 in children with sepsis myocardial injury increased,which are related to poor prognosis and myocardial injury indexes.