血清Troponin I,CK-MBmass,Myoglobin在急性心肌梗塞诊断中的应用评价

为了解CTnI，CK－MBmass和Mb指标对急性心肌梗塞（AMI）早期诊断、后期监测及预后判断的临床意义，采用微粒子化学发光法，对20例AMI患者、24例不稳定心绞痛（UA）患者、17例骨骼肌损伤（SM）患者和19例健康者（对照组）进行血清CTnI，CK－MBmass和Mb的测定，并对AMI患者胸病发生3～5小时，8～14小时，20～24小时，72小时和7天共五个时段进行了测定。结果：AMI患者发病早期CTnI，CK－MBmass和Mb的阳性检出率分别为65％，70％，70％，CTnI在UA患者组和SM患者组中未检出。CTnI，CK－MBmass和Mb测定值含量在AMI组中明显高于UA组和SM组，AMI患者组CTnI分别是UA组和SM组的84倍和91.63倍，CK－Mbmass分别是该二组的8．82倍和4．67倍，Mb分别是该二组的11．57倍和2．25倍，AMI组与UA组和SM组比较，有显著性差异（P＜0．001）。AMI患者组中该三项指标的动态测定显示，在疾病发生早期（3～5小时）时，CTnI，CK－MBmass和Mb都有显著性升高，随时间延长而逐渐升高，高峰值期均在8～14小时段，72小时时Mb已基本回到正常。7天时血清中仍有CTnI的持续存在，但CK－MBmass已接近正常。以上显示，CTnI，CK－MBmass和Mb在早期诊断AMI时，都具有较高的敏感性，CTnI在AMI患者中的阳性检出率具有心肌特异性。

Third generation biosensor based on myoglobin-TiO_2/MWCNTs modified glassy carbon electrode

TiO2 nanoparticles were homogeneously coated on multi-walled carbon nanotubes by hydrothermal deposition, this nanocomposite may be a promising material for myoglobin immobilization in view of its high biocompatibility and large surface. The glassy carbon electrode modified with Mb-TiO2/MWCNTs films exhibited a pair of weU defined, stable and nearly reversible cycle voltammetric peaks. The electron transfer between Mb and electrode surface, Ks of 3.08 s^-1, was greatly facilitated in the TiO2/ MWCNTs film. The electrocatalytic reductions of hydrogen peroxide were studied, the apparent Michaelis-Menten constant is calculated to be 83.10 μmol/L, which shows a large catalytic activity of Mb in the TiO2/MWCNTs film to H2O2.

RIG-I,a novel DAMPs sensor for myoglobin,activates NF-κB/caspase-3 signaling in CS-AKI model

Background:Acute kidney injury(AKI)is the main life-threatening complication of crush syndrome(CS),and myoglobin is accepted as the main pathogenic factor.The pattern recognition receptor retinoicacid-inducible gene I(RIG-I)has been reported to exert anti-viral effects function in the innate immune response.However,it is not clear whether RIG-I plays a role in CS-AKI.The present research was carried out to explore the role of RIG-I in CS-AKI.Methods:Sprague-Dawley rats were randomly divided into two groups:the sham and CS groups(n=12).After administration of anesthesia,the double hind limbs of rats in the CS group were put under a pressure of 3 kg for 16 h to mimic crush conditions.The rats in both groups were denied access to food and water.Rats were sacrificed at 12 h or 36 h after pressure was relieved.The successful establishment of the CS-AKI model was confirmed by serum biochemical analysis and renal histological examination.In addition,RNA sequencing was performed on rat kidney tissue to identify molecular pathways involved in CS-AKI.Furthermore,NRK-52 E cells were treated with 200μmol/L ferrous myoglobin to mimic CS-AKI at the cellular level.The cells and cell supernatant samples were collected at 6 h or 24 h.Small interfering RNAs(siRNA)was used to knock down RIG-I expression.The relative expression levels of molecules involved in the RIG-I pathway in rat kidney or cells samples were measured by quantitative real-time PCR(qPCR),Western blotting analysis,and immunohistochemistry(IHC)staining.Tumor necrosis factor-α(TNF-α)was d etected by ELISA.Co-immunoprecipitation(Co-IP)assays were used to detect the interaction between RIG-I and myoglobin.Results:RNA sequencing of CS-AKI rat kidney tissue revealed that the different expression of RIG-I signaling pathway.qPCR,Western blotting,and IHC assays showed that RIG-I,nuclear factor kappa-B(NF-κB)P65,p-P65,and the a poptotic marker caspase-3 and cleaved caspase-3 were up-regulated in the CS group(P<0.05).However,the levels of interferon regulatory factor 3(IRF3),p-IRF3 and the antiviral factor interferon-beta(IFN-β)showed no significant c hanges between the sham and CS groups.Co-IP assays showed the interaction between RIG-I and myoglobin in the kidneys of the CS group.Depletion of RIG-I could alleviate the myoglobin induced expression of apoptosis-associated molecules via the NF-κB/caspase-3 axis.C onclusions:RIG-I is a novel damage-associated molecular patterns(DAMPs)sensor for myoglobin and participates in the NF-κB/caspase-3 signaling pathway in CS-AKI.In the development of CS-AKI,specific intervention in the RIG-I p athway might be a potential therapeutic strategy for CS-AKI.

Direct Electrochemistry of Myoglobin in DDAB-Clay Composite Films

Ordered films were made by casting a mixture of aqueous dispersions of didodecyldimethylammonium bromide (DDAB)-clay composite and myoglobin (Mb) solution on pyrolytic graphite (PG) electrodes. The Mb-DDAB-clay film electrodes showed stable and reversible cyclic voltammetric responses in buffers and can catalyze the reduction of id (TCA).

Myoglobin as Mimetic Enzyme and Its Analytical Application in Determination of H_2O_2

The characteristic of Myoglobin as mimetic enzyme was studied and applied in the determination of HeO2 with o-phenylenediamine as substrate. The absorbanee obtained at 40 ℃ was found to be proportional to the concentration of H2O2 in the range of 2.0×10^-5- 2.0×10^-7 mol/L, with a correlation coefficient of 0.999 1. The proposed meth od is simple and highly sensitive to a detection limit of 2.7 × 10^-8 mol/L. The relative standard deviations were within 5% for the determination of different concentrations of H2O2. Satisfied results were obtained in the determination of H2O2 in rainwater by this method, and the recoveries were at the range of 97.2%-105.4%.

Expression of Myoglobin in the Urine of Cocaine Users

Background: The possibility exists that cocaine use in the absence of frank clinical presentation of acute cardiac events may be associated with subclinical injury including the release of myoglobin which is a nonspecific marker for cardiac and skeletal muscle damage. Objectives: This investigation examined urine specimens for potential differences between cocaine use and the expression of myoglobin (a marker associated with cardiovascular damage, inflammation and oxidative stress). Methods:40 urine specimens were assayed for cocaine metabolites, creatinine, total protein (BSA) and myoglobin using ELISA and colorimetry. Results: We observed significant differences between male control and male cocaine positive urines for myoglobin. Interestingly, there was no statistically significant difference in females between control and cocaine positive urines. Conclusion: Differences in the urinary expression of myoglobin may be important in evaluating the gender based effects of cocaine use and may have potential clinical applications which may be related to gender differences in signs and symptoms of cocaine toxicity.

Availability of Myoglobin as a Molecular Marker for Phylogenetic Relationships of Fish

In order to elucidate the phylogenetic relationship of fish, DNA and deduced amino acid sequences of myoglobin （Mb） were used for the phylogenetic analyses based on different approaches, namely, maximum likelihood （ML）, neighbor joining （NJ）, unweighted pair group method with arithmetic means （UPGMA） and maximum parsimony （MP） methods in comparison with the conventional molecular markers, mitochondrial cytochrome b （cyt-b） and cytochrome c oxidase subunit I （COI）. The phylogenetic trees drawn based on Mb sequences were similar to those by the traditional classification based on the other molecular markers. The primary and secondary structures, as well as the modeled tertiary structures of Mbs were similar to each other, but were clearly distinguishable among those species. Such differences in structure would be associated with adaptation of Mb molecule to the physiological conditions of each species. These results suggest that Mb can be a molecular marker for the phylogenetic relationship of fish.

Allergenic risk assessment of porcine myoglobin expressed by engineered Komagataella Phaffii

Myoglobin produced by fermentation using engineered Komagataella phaffii is an important color additive in meat analogue products,but its allergenicity is poorly understood.Here,we initially searched the Allergen Online database and did not find any allergic or cross-reactive proteins in porcine myoglobin(PM).In vitro simulated digestion demonstrated that PM did not exhibit notable acid-base resistance or anti-digestion capabilities.However,sensitization was observed in BALB/c mice,including a significant increase in specific antibodies and biomarkers for allergic reactions,as well as alterations in gut microbiome and serum metabolome.Interestingly,the intensity of sensitization exhibited a negative correlation with the purity of PM.60%and 88%purities showed weaker sensitization compared to the ovalbumin control group.These allergic reactions were likely due to the non-myoglobin protein portion,highlighting the importance of purification processes and the urgent need to assess the allergenicity of this portion.

Serum procalcitonin levels are associated with rhabdomyolysis following exertional heatstroke: an over 10-year intensive care survey

BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.

老年舒张性心力衰竭合并肌少症患者可溶性生长刺激表达基因2蛋白、肌红蛋白、白细胞介素-6水平与心功能的相关性

目的 探讨老年舒张性心力衰竭(DHF)合并肌少症患者外周血可溶性生长刺激表达基因2蛋白(sST2)、肌红蛋白(Myo)、白细胞介素-6(IL-6)水平与心功能的相关性。方法 将122例DHF患者根据有无肌少症分为DHF合并肌少症组60例和DHF组62例,另将健康体检者58例、单纯肌少症患者60例分别纳入对照组、单纯肌少症组,检测各组外周血sST2、Myo、IL-6水平和心功能指标[左室射血分数(LVEF)、心排血量(CO)、心率(HR)、每搏输出量(SV)和心脏指数(CI)]。采用Pearson相关分析法分析sST2、Myo、IL-6与各心功能指标的相关性。绘制受试者工作特征(ROC)曲线,分析sST2、Myo、IL-6单独及联合诊断DHF合并肌少症的效能。结果 与对照组、单纯肌少症组相比,DHF组、DHF合并肌少症组sST2、Myo、IL-6水平和HR均升高,LVEF、CO、SV和CI均降低,差异有统计学意义(P<0.05);与DHF组相比,DHF合并肌少症组sST2、Myo、IL-6水平和HR均升高,LVEF、CO、SV和CI均降低,差异有统计学意义(P<0.05)。sST2、Myo、IL-6均分别与LVEF、CO、SV、CI呈负相关(P<0.001),均与HR呈正相关(P<0.001);sST2、Myo、IL-6、LVEF、SV是DHF合并肌少症的独立影响因素(P<0.05);sST2、Myo、IL-6联合诊断DHF合并肌少症的曲线下面积为0.936,诊断效能优于三者单独检测。结论 老年DHF合并肌少症患者外周血sST2、Myo、IL-6水平显著升高,且sST2、Myo、IL-6均与心功能指标显著相关,三者联合检测对DHF合并肌少症的诊断效能较高。

Exertional Rhabdomyolysis Induced Acute Kidney Injury: A Case Report and Literature Review

Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circumstances, or sudden and excessive skeletal muscle contraction. It may manifest from the increase in CK (creatine kinase) or MYO (myoglobin), a protein that can cause life-threatening injury to the kidney (AKI, acute kidney injury), and may or may not be associated with myoglobinuria. Here, we presented a case of exRML with AKI, and then reviewed the related reports. Vigorous hydration, sodium bicarbonate and furosemide are key treatments. Aim: To examine an elderly patient with exRML induced AKI and the key treatment process. Case summary: A 61-year-old man left our hospital without permission after his admission and has been walking for almost 30 kms with no water and food intake, then was diagnosed exRML and exRML induced AKI with an obvious elevation of CK, MYO and decrease of eGFR (estimated glomerular filtration rate) after coming back, and was treated with vigorous hydration, loop diuresis, sodium bicarbonate, prostaglandin and Shenkang injection. After vigorous resuscitation, the patient’s renal function, CK and MYO returned normal. Conclusions: The exRML can cause serious complications such as AKI and death. Delayed diagnosis can be critical;therefore, manner of time should be taken to achieve a favorable prognosis.

NT-proBNP、cTnI、Mb对风湿性心脏病患者人工瓣膜置换术预后情况的预测价值

目的:探讨N-末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、肌红蛋白(Mb)对风湿性心脏病(RHD)人工瓣膜置换术预后情况的预测价值。方法:选取2020年1月-2022年12月烟台市烟台山医院收治的RHD患者60例为研究对象,均接受人工瓣膜置换术治疗。比较预后良好组(n=47)、预后不良组(n=13)NT-proBNP、cTnI、Mb、左室射血分数(LVEF)水平,分析NT-proBNP、cTnI、Mb与LVEF的相关性,分析NT-proBNP、cTnI、Mb对RHD预后不良的预测效能。结果:预后不良组NT-proBNP、cTnI、Mb水平高于预后良好组,LVEF水平低于预后良好组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,NT-proBNP、cTnI、Mb分别与LVEF呈负相关,差异有统计学意义(r=-0.685、-0.636、-0.614,P=0.016、0.022、0.027)。NT-proBNP、cTnI、Mb联合预测RHD预后不良的曲线下面积高于各单一指标,差异有统计学意义(P<0.05)。结论:NT-proBNP、cTnI、Mb与RHD预后情况相关,RHD患者血清NT-proBNP、cTnI、Mb含量升高,提示病情恶化风险增加,NT-proBNP、cTnI、Mb联合预测RHD预后有一定价值。

新型冠状病毒奥密克戎变异株感染老年患者的临床特征分析

目的分析奥密克戎变异株感染老年患者的临床特征。方法收集2022年10月至2023年1月该院收治的516例奥密克戎变异株感染老年患者的临床资料,分析患者临床资料,参照《新型冠状病毒肺炎诊疗方案(试行第十版)》诊断并分型。结果516例老年患者轻型56例,中型256例,重型94例,危重型110例。中型、重型及危重型老年感染患者的实验室检查中白细胞计数下降、中性粒细胞计数升高、淋巴细胞百分比下降、C反应蛋白升高、肌红蛋白升高、尿素氮升高者的比例与轻型患者比较,差异均有统计学意义(P<0.05);老年患者胸部CT以双肺改变为主(81.40%),其中又以磨玻璃影(94.52%)、斑片状(77.62%)、铺路石样(32.38%)改变为主;516例患者中存活439例,死亡77例,多因素Logistic回归分析显示,年龄大、淋巴细胞百分比下降、肌红蛋白升高、D-二聚体升高、降钙素原升高是老年感染患者死亡的独立危险因素(P<0.05)。结论年龄、淋巴细胞百分比、肌红蛋白、D-二聚体、降钙素原与老年感染患者死亡风险具有紧密联系。

荣昌猪、约荣猪和杜长大三元猪肉色与肌红蛋白相关性研究

【目的】探究荣昌猪、大约克夏猪×荣昌猪(约荣猪)与杜洛克猪×长白猪×大白猪(杜长大三元猪)的肉色和肉中肌红蛋白含量差异,验证肉色与肌红蛋白的相关性,为商品猪肉色评价提供基础数据。【方法】采集荣昌猪(n=15)、约荣猪(n=20)、杜长大三元猪(n=20)背最长肌肉样,结合肉色度值、可见吸收光谱及公式对宰后45 min、6 h、12 h和24 h荣昌猪、约荣猪、杜长大三元猪的肉色和肌红蛋白含量分别进行测算,并探究猪肉色和肌红蛋白的关联性。【结果】荣昌猪肉红度值显著高于杜长大三元猪(P<0.05);宰后45 min,3种猪肉亮度值显著低于其他时间点(P<0.05)。3种猪肌红蛋白扫描光谱在543和580 nm处出现氧合肌红蛋白特征峰,峰高显示荣昌猪>约荣猪>杜长大三元猪。宰后45 min,荣昌猪肉中总肌红蛋白含量显著高于约荣猪和杜长大三元猪(P<0.05),氧合肌红蛋白含量显著高于杜长大三元猪(P<0.05),高铁肌红蛋白相对含量显著低于约荣猪和杜长大三元猪(P<0.05)。宰后24 h,荣昌猪肉中高铁肌红蛋白含量及氧合肌红蛋白、高铁肌红蛋白相对含量均显著高于45 min和6 h(P<0.05)。相关性分析显示,红度值、总肌红蛋白和氧合肌红蛋白含量之间存在显著高度正相关(P<0.05)。【结论】荣昌猪肉因红度值高、总肌红蛋白含量高和高铁肌红蛋白相对含量低而肉色更鲜红,猪肉色优劣与肌红蛋白含量及其氧化还原状态密切相关。

不同pH值对肌红蛋白构象及热稳定性的影响

为探究不同pH值对肌红蛋白结构及热稳定性的影响,采用体外实验,以正常pH值(5.6)和高pH值(6.4)肌红蛋白溶液为研究对象,利用多光谱分析技术探究冷藏(4℃)和加热(72℃)条件下不同pH值对肌红蛋白分子结构、表面疏水性和热变性程度的影响。结果表明:4℃孵育条件下,2种pH值对肌红蛋白构象无明显影响,而72℃加热条件下,pH 5.6肌红蛋白溶液的内源荧光强度、蛋白质表面疏水性和热变性程度显著高于pH 6.4;相比于pH 6.4时,pH 5.6时的肌红蛋白分子的三级结构受到更严重的破坏,热稳定性降低。因此,环境pH值可以通过改变肌红蛋白的结构稳定性,进而改变肌红蛋白的热稳定性,高pH值可以增加肌红蛋白的热稳定性,是导致DFD(dark,firm,dry)牛肉熟制时持续粉红现象的重要原因。

油橄榄叶提取物对HaCaT细胞氧化损伤的保护作用及抑菌活性

为研究油橄榄叶提取物对人永生化角质形成细胞(HaCaT)氧化损伤的保护作用及抑菌作用,采用肌红蛋白保护率评价油橄榄叶提取物对不同种类自由基的胞外抗氧化能力,建立HaCaT细胞的氧化损伤和炎症模型,评价油橄榄叶提取物对细胞氧化损伤的保护作用,并进一步考察油橄榄叶提取物对常见病原菌的抑制作用。结果表明油橄榄叶提取物对羟基自由基、次氯酸根和过氧自由基均具有抗氧化作用,其中对羟基自由基和过氧自由基的抗氧化效果较好。在细胞水平上,油橄榄叶提取物能够显著降低HaCaT的胞内自由基,可以有效改善HaCaT细胞的氧化应激状态。同时,0.156~0.625μg/mL的油橄榄叶提取物能够有效降低炎症细胞中的白细胞介素6(interleukin-6,IL-6)和白细胞介素1β(interleukin-1β,IL-1β)因子水平,0.156~0.312μg/mL的提取物能够降低肿瘤坏死因子(tumor necrosis factor-α,TNF-α)水平。此外,油橄榄叶提取物能够有效抑制金黄色葡萄球菌,而对大肠杆菌和铜绿假单胞菌敏感度低。综上,油橄榄叶提取物对HaCaT细胞的氧化损伤具有一定的保护作用,且具有抗炎效果和抑菌活性。

不同超高压处理对DFD牛肉肉色及货架期的影响

为降低DFD(dark,firm and dry)牛肉初始菌落总数,延长真空包装DFD牛肉货架期并改善肉色,以不同压力(200、400、600 MPa)配合不同加压时间(5、10 min)的超高压处理为实验组,以空白处理为对照组,测定真空包装DFD牛肉在(2±2)℃条件下贮藏0、2、4、6、8、12、16 d后的肉色、表观肉色图像、pH值、微生物和3种肌红蛋白相对含量,探究超高压处理对DFD牛肉货架期及肉色的影响,进而探寻适合DFD牛肉肉色改善和货架期延长的超高压处理条件。结果表明:超高压能显著提高DFD牛肉的亮度值、红度值和黄度值(P<0.05),增加氧合肌红蛋白的相对含量,降低高铁肌红蛋白的相对含量,但过高压力(600 MPa)会使DFD牛肉呈现粉红色;超高压处理能显著降低DFD牛肉初始菌落总数(P<0.05),200 MPa(5、10 min)处理组使DFD牛肉初始菌落总数降低0.6、0.8(lg(CFU/g)),400 MPa(5、10 min)处理组降低1.1、1.3(lg(CFU/g)),600 MPa(5、10 min)处理组降低1.7、2.0(lg(CFU/g)),有效抑制了微生物在贮藏期间的生长;对照组在12 d时已腐败,200 MPa处理组在16 d时达到腐败限值,而冷藏16 d,400、600 MPa处理组均未腐败;400 MPa是有效改善DFD牛肉肉色、延长其货架期的最适压力,保压时间的延长对肉色和货架期的影响不显著(P>0.05)。综合考虑,400 MPa-10 min是超高压处理DFD牛肉的最适参数,能改善DFD牛肉肉色,同时将货架期至少延长5 d以上。

血清CK、Mb联合血乳酸预测多发伤患者短期预后的价值

目的研究血清肌酸激酶(CK)、肌红蛋白(Mb)联合血乳酸预测多发伤患者短期预后的价值。方法回顾性分析黄冈市中心医院2019年9月—2022年9月收治的78例多发伤患者的临床资料,根据30 d后临床结局,将患者分为预后良好组(存活,共68例)及预后不良组(死亡,共10例)。收集患者一般资料,包括性别、年龄、受伤部位、受伤原因、心率、平均动脉压(MAP)、有无急诊插管、有无急诊心脏复苏术(CPR)、急诊输血次数,检测两组CK、Mb及血乳酸水平。比较两组临床资料差异;通过ROC分析CK、Mb及血乳酸预测多发伤短期预后不良的价值;以一致性分析CK、Mb及血乳酸联合预测多发伤短期预后不良的准确率;将两组有差异信息纳入Logistic模型,行量化赋值,明确多发伤预后不良的危险因素。结果预后良好组CK、Mb、血乳酸水平均明显低于预后不良组(P<0.05),预后良好组MAP≤90 mmHg、急诊插管、急诊CPR人数明显少于预后不良组(P<0.05)。两组在性别构成、年龄、受伤部位、受伤原因、心率、急诊输血次数方面无统计学差异(P>0.05)。经ROC分析证实CK、Mb及血乳酸能够预测多发伤短期预后不良,曲线下面积为0.625、0.783、0.796,均有P<0.05。联合检测采用串联试验,经一致性分析,CK、Mb及血乳酸联合预测多发伤短期预后不良的灵敏度0.800,特异度0.985,准确率96.20%,Kappa=0.820。将两组有差异信息纳入Logistic模型,行量化赋值,证实MAP≤90mmHg、急诊插管、急诊CPR、CK≥729.375μg/L、Mb≥358.260 U/L、血乳酸≥2.955 mmol/L是多发伤短期预后不良的危险因素(P<0.05)。结论CK、Mb、血乳酸均可预测多发伤患者短期预后不良,且三者联合能够更好预测多发伤患者短期预后不良。

蘑菇中毒导致心肌损伤的危险因素分析及预测模型构建与验证

目的 回顾性分析蘑菇中毒患者发生心肌损伤的危险因素并构建与验证预测模型。方法 将2012年7月至2023年9月湖南省人民医院和广西壮族自治区贵港市平南县人民医院收治的蘑菇中毒患者211例,根据中毒后有无心肌损伤情况分为两组,比较两组中毒患者的一般资料、心肌酶谱、心电图等情况,采用单因素和多因素回归分析蘑菇中毒患者发生心肌损伤的危险因素,并据此构建与验证危险因素预测模型。结果 单因素分析显示,心肌损伤组患者乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、肌红蛋白、肌钙蛋白Ⅰ、心电图异常均高于非心肌损伤组患者(P均<0.05),血红蛋白、血钙均低于非心肌损伤组患者(P均<0.05)。多因素回归分析结合ROC曲线分析表明,肌红蛋白、肌钙蛋白Ⅰ水平升高,血钙水平降低,以及心电图异常是蘑菇中毒导致心肌损伤的独立危险因素。通过Hosmer-Lemeshow检验,模型的内部一致性良好,拟合优度高(P>0.05)。结论 肌红蛋白、肌钙蛋白Ⅰ、血钙、心电图异常是预测蘑菇中毒导致心肌损伤的重要因素。在临床实践中,应重视高危因素的识别,监测相关指标,并及时采取干预治疗,以促进患者康复。

连续性肾脏替代治疗联合血液灌流在横纹肌溶解合并急性肾损伤中的研究进展

横纹肌溶解(rhabdomyolysis,RM)是一种多因素造成的骨骼肌损伤及其分解产物释放入血液循环中的临床综合征。急性肾损伤(acute kidney injury,AKI)是横纹肌溶解的常见并发症,主要与肌红蛋白堵塞肾小管及其直接肾毒性作用有关。RM合并AKI的治愈率较低、死亡率较高。既往有研究显示连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)联合血液灌流(hemoperfusion,HP)可以有效治疗RM合并AKI,本文就CRRT联合HP治疗RM合并AKI进行了综述,旨在为临床治疗决策及后续研究提供参考。