单核细胞与高密度脂蛋白比值、高迁移率族蛋白B1对脓毒症患者心肌损伤的预测价值

Prognostic value of ratio of monocyte to high-density lipoprotein combined with high mobility group protein B1 in patients with septic myocardial injury

  • 摘要:
    目的 探讨单核细胞与高密度脂蛋白比值(MHR)联合高迁移率族蛋白B1(HMGB1)对脓毒症患者心肌损伤的预测价值。
    方法 选取100例脓毒症患者作为研究对象,根据是否合并心肌损伤分为合并心肌损伤组40例、未合并心肌损伤组60例,另选取同期90例健康体检人员作为对照组,比较3组血清MHR、HMGB1水平。采用单因素分析及多因素Logistic回归分析探讨脓毒症患者合并心肌损伤的影响因素,采用受试者工作特征(ROC)曲线分析MHR、HMGB1对脓毒症患者心肌损伤的预测价值。
    结果 未合并心肌损伤组、合并心肌损伤组血清MHR、HMGB1水平高于对照组,且合并心肌损伤组高于未合并心肌损伤组,差异有统计学意义(P<0.05);合并心肌损伤组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分和心肌肌钙蛋白Ⅰ(cTnⅠ)、氨基末端脑钠肽前体(NT-proBNP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平高于未合并心肌损伤组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分、SOFA评分、NT-proBNP、cTnⅠ、IL-6、TNF-α是脓毒症患者心肌损伤的独立影响因素(P<0.05)。ROC曲线分析结果显示,MHR与HMGB1联合预测脓毒症患者心肌损伤的价值高于MHR、HMGB1单独预测(P<0.05)。
    结论 MHR、HMGB1在脓毒症心肌损伤患者血清中表达升高,两者联用可有效预测脓毒症患者心肌损伤。依据脓毒症患者心肌损伤的主要危险因素制订针对性措施并实施,对改善患者预后具有积极意义。

     

    Abstract:
    Objective To explore the value of ratio of monocyte to high-density lipoprotein(MHR) combined with high mobility group protein B1 (HMGB1)for predicting myocardial injury in septic patients.
    Methods A total of 100 patients with sepsis were selected as study objects, and were divided into myocardial injury group(40 cases) and without myocardial injury group (60 cases) according to whether the patients complicated with myocardial injury or not. Another 90 healthy people in the same period were selected as control group. The serum levels of MHR and HMGB1 were compared among three groups. Univariate analysis and multivariate Logistic regression analysis were used to explore the influencing factors of sepsis patients complicating with myocardial injury. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of MHR and HMGB1 on myocardial injury in sepsis patients.
    Results Compared with the control group, the levels of MHR and HMGB1 were increased in the myocardial injury group and without myocardial injury group, the levels of MHR and HMGB1 in the myocardial injury group were higher than those in the without myocardial injury group(P < 0.05). Acute Physiology and Chronic Health Status Score System Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score and cardiac troponin Ⅰ (cTnⅠ), amino-terminal brain natriuretic peptide precursor (NT-proBNP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) levels were higher in the myocardial injury group were higher than those in the without myocardial injury group (P < 0.05). Multivariate Logistic regression analysis showed that APACHE Ⅱ score, SOFA score, NT-proBNP, cTnⅠ, IL-6 and TNF-α were independent influencing factors of myocardial injury in sepsis patients (P < 0.05). ROC curve analysis showed that MHR combined with HMGB1 had a higher value in predicting myocardial injury in sepsis patients than MHR and HMGB1 alone (P < 0.05).
    Conclusion The expression levels of MHR and HMGB1 in serum of sepsis patients with myocardial injury are increased, and the combination of MHR and HMGB1 can effectively predict myocardial injury in patients with sepsis. According to the main risk factors of myocardial injury in patients with sepsis, the formulation and implementation of targeted measures are of positive significance to improve the prognosis of patients.

     

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